| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $28.84 | $28.84 | $29.51 | |
Aetna
| Professional | $28.84 | $28.84 | $37.15 | |
Cigna
| Professional | $870.96 | $870.96 | $870.96 | |
Hally Health
| Professional | $120.23 | $169.82 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |