| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $61.66 | $61.66 | $61.66 |
Cigna
| Facility | 26 | $12.59 | $58.88 | $83.18 |
Health Alliance Plan
| Facility | 26 | $47.86 | $117.49 | $131.83 |
Priority Health
| Facility | 26 | $12.59 | $58.88 | $83.18 |