| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $166.83 | $166.83 | $177.26 | |
Cigna
| Professional | $177.26 | $177.26 | $177.26 | |
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $166.83 | $200.20 | $782.03 | |
Medica
| Professional | $792.45 | $792.45 | $792.45 |