| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.98 | $16.98 | $16.98 | |
Aetna
| Professional | $16.98 | $16.98 | $18.20 | |
Cigna
| Professional | $18.20 | $18.20 | $18.20 | |
Hally Health
| Professional | $151.36 | $199.53 | $275.42 | |
Medica
| Facility | $17.38 | $19.95 | $100.00 | |
Medica
| Professional | $81.28 | $81.28 | $81.28 |