| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $855.25 | $1,447.83 | $2,168.50 | |
Aetna
| Professional | $855.25 | $855.25 | $855.25 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Medcost
| Facility | $855.25 | $855.25 | $1,197.34 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |