| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $67.61 | $128.82 | $302.00 |
Cigna
| Facility | 26 | $18.62 | $87.10 | $125.89 |
Medcost
| Professional | 26 | $144.54 | $144.54 | $144.54 |
Wellcare
| Facility | 26 | $478.63 | $478.63 | $478.63 |