| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $918.74 | $1,294.58 | $4,000.00 | |
Aetna
| Facility | 25 | $602.40 | $2,248.19 | $4,021.76 |
Aetna
| Professional | 25 | $171.30 | $408.70 | $573.66 |
Cigna
| Facility | $991.62 | $991.62 | $991.62 |