| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $89.42 | $123.73 | $123.73 |
Cigna
| Facility | 26 | $154.99 | $181.12 | $240.73 |
Medica
| Facility | 26 | $276.95 | $276.95 | $276.95 |
Quartz
| Facility | 26 | $140.97 | $276.95 | $276.95 |