| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $390.68 | $781.36 | $944.33 | |
Aetna
| Professional | $239.37 | $239.37 | $239.37 | |
Medcost
| Facility | $239.37 | $246.55 | $406.93 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 | |
Wellcare
| Professional | $392.70 | $448.80 | $448.80 |