| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $55.22 | $55.22 | $55.22 | |
Aetna
| Professional | $40.34 | $48.16 | $56.18 | |
Cigna
| Facility | $65.03 | $65.03 | $65.03 | |
Cigna
| Professional | $49.10 | $49.10 | $50.22 | |
Hally Health
| Professional | $49.70 | $61.02 | $115.96 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $65.17 | $71.79 | $76.25 | |
Molina
| Professional | $32.34 | $32.34 | $86.22 | |
United
| Professional | $52.84 | $70.95 | $111.52 |