| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $104.40 | $104.40 | $104.40 | |
Cigna
| Facility | $89.99 | $89.99 | $89.99 | |
Cigna
| Professional | $89.99 | $89.99 | $89.99 | |
Medcost
| Facility | $104.40 | $104.40 | $117.97 | |
Wellcare
| Facility | $80.00 | $100.00 | $100.00 |