| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $21.24 | $21.24 | $21.24 | |
Cigna
| Professional | $228.00 | $228.00 | $228.00 | |
Hally Health
| Professional | $22.01 | $91.88 | $155.02 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |