| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.07 | $179.84 | $371.64 | |
Aetna
| Facility | 25 | $8.15 | $19.07 | $872.25 |
Cigna
| Facility | $111.66 | $111.66 | $111.66 | |
Medcost
| Facility | $122.51 | $163.71 | $245.04 | |
Wellcare
| Facility | $212.91 | $221.00 | $523.65 |