| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $77.62 | $77.62 | $77.62 |
Cigna
| Facility | 26 | $15.85 | $74.13 | $107.15 |
Health Alliance Plan
| Facility | 26 | $54.95 | $138.04 | $151.36 |
Priority Health
| Facility | 26 | $15.85 | $74.13 | $107.15 |