| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $89.13 | $91.20 | $91.20 |
Cigna
| Facility | 26 | $18.62 | $87.10 | $125.89 |
Health Alliance Plan
| Facility | 26 | $69.18 | $169.82 | $190.55 |
Priority Health
| Facility | 26 | $18.62 | $87.10 | $125.89 |