| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $120.59 | $132.08 | $201.07 |
Cigna
| Facility | 26 | $137.06 | $137.06 | $137.06 |
Medcost
| Facility | 26 | $174.03 | $212.12 | $350.22 |
Wellcare
| Facility | 26 | $876.64 | $1,102.00 | $1,102.00 |