| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.69 | $104.69 | $6,793.70 | |
Aetna
| Professional | $102.23 | $104.69 | $104.69 | |
Cigna
| Professional | $62.16 | $62.16 | $62.16 | |
Hally Health
| Professional | $120.00 | $200.00 | $345.40 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |