| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $367.54 | $367.54 | $440.35 | |
Medcost
| Professional | $106.00 | $106.00 | $106.00 | |
Wellcare
| Facility | $125.74 | $197.84 | $228.35 | |
Wellcare
| Professional | $406.32 | $406.32 | $406.32 |