| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.02 | $19.02 | $19.02 | |
Aetna
| Professional | $19.02 | $19.02 | $20.21 | |
Cigna
| Professional | $11.05 | $11.05 | $11.05 | |
Hally Health
| Professional | $120.00 | $200.00 | $345.40 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |