| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $76.67 | $106.94 | $106.94 |
Cigna
| Facility | 26 | $133.37 | $155.85 | $207.14 |
Medica
| Facility | 26 | $240.42 | $240.42 | $240.42 |
Quartz
| Facility | 26 | $121.75 | $240.42 | $240.42 |