| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $50.90 | $630.00 | $630.00 | |
Cigna
| Facility | $1,051.59 | $1,051.59 | $1,051.59 | |
Cigna
| Professional | $893.86 | $1,051.59 | $1,051.59 | |
Wellcare
| Facility | $100.00 | $100.00 | $590.84 |