| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $75.59 | $75.59 | $179.09 |
Cigna
| Facility | 26 | $85.69 | $85.69 | $85.69 |
Medcost
| Facility | 26 | $103.17 | $119.04 | $201.15 |
Wellcare
| Facility | 26 | $178.70 | $178.70 | $363.33 |