| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $239.88 | $707.95 | $3,630.78 | |
Aetna
| Professional | $239.88 | $239.88 | $707.95 | |
Cigna
| Professional | $63.10 | $63.10 | $63.10 | |
Hally Health
| Professional | $120.23 | $169.82 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |