| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $204.17 | $204.17 | $204.17 |
Cigna
| Facility | 26 | $36.31 | $169.82 | $245.47 |
Health Alliance Plan
| Facility | 26 | $165.96 | $407.38 | $457.09 |
Priority Health
| Facility | 26 | $36.31 | $169.82 | $245.47 |