| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $57.54 | $66.07 | $89.13 |
Cigna
| Facility | 26 | $22.91 | $107.15 | $151.36 |
Lucent Health
| Facility | 26 | $588.84 | $1,071.52 | $1,071.52 |
Moda Health
| Facility | 26 | $57.54 | $66.07 | $77.62 |
Providence
| Facility | 26 | $22.91 | $107.15 | $151.36 |