| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $78.66 | $108.79 | $108.79 |
Cigna
| Facility | 26 | $136.07 | $159.01 | $211.33 |
Medica
| Facility | 26 | $239.22 | $239.22 | $239.22 |
Quartz
| Facility | 26 | $123.88 | $239.22 | $239.22 |