| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $455.49 | $2,374.64 | $3,598.27 | |
Aetna
| Facility | 50 | $1,334.25 | $2,679.90 | $6,873.94 |
Aetna
| Professional | 50 | $467.85 | $1,776.41 | $2,744.55 |
Kaiser Permanente
| Professional | $613.65 | $2,480.73 | $3,961.44 |