| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $70.69 | $85.15 | $122.27 |
Cigna
| Facility | 26 | $80.88 | $80.88 | $80.88 |
Medcost
| Facility | 26 | $113.03 | $147.80 | $221.90 |
Wellcare
| Facility | 26 | $514.72 | $514.72 | $690.00 |