| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.66 | $119.54 | $142.69 | |
Aetna
| Professional | $83.52 | $119.54 | $119.54 | |
Cigna
| Professional | $46.50 | $46.50 | $58.13 | |
Medcost
| Facility | $74.95 | $106.66 | $119.54 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |