| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $66.84 | $73.43 | $155.88 | |
Aetna
| Professional | $57.69 | $66.84 | $81.30 | |
Cigna
| Professional | $94.93 | $94.93 | $142.91 | |
Hally Health
| Professional | $69.93 | $105.60 | $160.91 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $89.70 | $95.46 | $142.96 | |
Molina
| Professional | $32.34 | $32.34 | $164.96 | |
United
| Professional | $69.56 | $100.17 | $145.08 |