| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $326.00 | $326.00 | $362.95 |
Cigna
| Facility | 26 | $406.41 | $474.92 | $631.20 |
Medica
| Facility | 26 | $714.54 | $714.54 | $714.54 |
Quartz
| Facility | 26 | $369.03 | $714.54 | $714.54 |