| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $77.50 | $108.09 | $108.09 |
Cigna
| Facility | 26 | $134.27 | $156.90 | $208.54 |
Medica
| Facility | 26 | $240.42 | $240.42 | $240.42 |
Quartz
| Facility | 26 | $122.28 | $240.42 | $240.42 |