| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.17 | $23.17 | $23.17 | |
Aetna
| Professional | $23.17 | $23.17 | $78.09 | |
Cigna
| Professional | $70.50 | $71.20 | $88.13 | |
Hally Health
| Professional | $21.83 | $124.56 | $161.04 | |
Medica
| Facility | $23.17 | $23.17 | $80.00 |