| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.51 | $22.51 | $22.51 | |
Aetna
| Professional | $9.00 | $22.51 | $22.51 | |
Cigna
| Professional | $153.75 | $155.29 | $192.19 | |
Hally Health
| Professional | $37.10 | $112.70 | $173.40 | |
Medica
| Facility | $22.51 | $38.27 | $75.00 |