| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $153.33 | $155.05 | $233.42 |
Cigna
| Facility | 26 | $172.08 | $172.08 | $172.08 |
Medcost
| Facility | 26 | $179.22 | $227.71 | $386.09 |
Wellcare
| Facility | 26 | $657.79 | $747.75 | $747.75 |