| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $247.07 | $247.07 | $415.13 |
Cigna
| Facility | 26 | $280.45 | $280.45 | $280.45 |
Medcost
| Facility | 26 | $276.85 | $415.00 | $455.00 |
Wellcare
| Facility | 26 | $1,811.20 | $2,206.88 | $2,206.88 |