| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.22 | $104.22 | $8,011.08 | |
Aetna
| Professional | $104.22 | $104.22 | $104.22 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Medcost
| Facility | $104.22 | $104.22 | $151.12 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |