| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $105.46 | $105.46 | $112.05 | |
Cigna
| Professional | $112.05 | $112.05 | $112.05 | |
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $105.46 | $118.12 | $479.89 | |
Medica
| Professional | $486.29 | $486.29 | $486.29 |