| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $125.87 | $177.53 | $177.53 |
Cigna
| Facility | 26 | $221.68 | $259.05 | $344.29 |
Medica
| Facility | 26 | $725.41 | $725.41 | $725.41 |
Quartz
| Facility | 26 | $201.38 | $725.41 | $725.41 |