| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $157.43 | $157.43 | $157.43 |
Cigna
| Facility | 26 | $178.90 | $178.90 | $178.90 |
Medcost
| Facility | 26 | $178.03 | $196.08 | $285.83 |
Wellcare
| Facility | 26 | $286.08 | $759.53 | $759.53 |