| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $97.74 | $136.46 | $136.46 |
Cigna
| Facility | 26 | $168.51 | $196.92 | $261.72 |
Medica
| Facility | 26 | $303.95 | $303.95 | $303.95 |
Quartz
| Facility | 26 | $153.65 | $303.95 | $303.95 |