| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $173.42 | $173.42 | $289.23 |
Cigna
| Facility | 26 | $196.61 | $196.61 | $196.61 |
Medcost
| Facility | 26 | $199.82 | $240.00 | $315.00 |
Wellcare
| Facility | 26 | $1,268.32 | $1,545.44 | $1,545.44 |