| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.21 | $1.21 | $1.21 | |
Aetna
| Professional | $1.21 | $1.21 | $1.42 | |
Hally Health
| Professional | $39.20 | $44.12 | $160.00 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $30.00 | $40.00 | $2,500.00 |