| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $18.23 | $18.23 | $19.38 | |
Cigna
| Professional | $19.38 | $19.38 | $19.38 | |
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $18.23 | $23.71 | $100.00 | |
Medica
| Professional | $86.64 | $86.64 | $86.64 |