| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $169.55 | $169.55 | $169.55 |
Cigna
| Facility | 26 | $193.73 | $193.73 | $193.73 |
Medcost
| Facility | 26 | $160.81 | $217.00 | $304.27 |
Wellcare
| Facility | 26 | $361.00 | $839.75 | $839.75 |