| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.16 | $22.16 | $22.16 | |
Aetna
| Professional | $22.16 | $22.16 | $78.50 | |
Cigna
| Professional | $113.63 | $114.76 | $142.03 | |
Hally Health
| Professional | $21.83 | $124.56 | $161.04 | |
Medica
| Facility | $22.16 | $22.16 | $80.00 |