| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.26 | $1.26 | $1.26 | |
Aetna
| Professional | $1.26 | $1.26 | $1.26 | |
Cigna
| Professional | $196.48 | $196.48 | $196.48 | |
Hally Health
| Professional | $282.80 | $387.45 | $432.95 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $30.00 | $40.00 | $2,500.00 |