| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $88.00 | $88.00 | $88.00 | |
Aetna
| Professional | $88.00 | $88.00 | $88.00 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Medcost
| Facility | $88.00 | $88.00 | $127.60 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |