| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $50.90 | $50.90 | $50.90 | |
Cigna
| Facility | $104.74 | $104.74 | $104.74 | |
Cigna
| Professional | $104.74 | $104.74 | $104.74 | |
Medcost
| Facility | $181.20 | $181.20 | $181.20 | |
Wellcare
| Facility | $90.00 | $100.00 | $100.00 |