| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.70 | $25.70 | $26.92 | |
Aetna
| Professional | $19.50 | $114.82 | $724.44 | |
Cigna
| Professional | $79.43 | $79.43 | $79.43 | |
Medcost
| Facility | $117.49 | $117.49 | $117.49 | |
Wellcare
| Facility | $165.96 | $165.96 | $165.96 |