| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.47 | $25.47 | $25.47 | |
Cigna
| Professional | $155.19 | $155.19 | $155.19 | |
Hally Health
| Professional | $84.70 | $117.40 | $154.10 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |