| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $350.00 | $756.83 | $1,878.00 | |
Aetna
| Facility | 25 | $602.39 | $927.15 | $2,381.03 |
Aetna
| Professional | 25 | $137.56 | $327.00 | $1,128.80 |
Ambetter
| Professional | 25 | $161.84 | $226.58 | $609.45 |