| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $69.52 | $124.54 | $181.33 |
Cigna
| Facility | 26 | $87.95 | $87.95 | $87.95 |
Medcost
| Facility | 26 | $104.46 | $120.52 | $212.93 |
Wellcare
| Facility | 26 | $181.03 | $375.01 | $375.01 |