| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $47.86 | $47.86 | $165.96 |
Cigna
| Facility | 26 | $120.23 | $138.04 | $223.87 |
Medica
| Facility | 26 | $218.78 | $218.78 | $218.78 |
Quartz
| Facility | 26 | $104.71 | $288.40 | $288.40 |