| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $140.97 | $689.09 | $5,323.21 | |
Aetna
| Facility | 50 | $64.22 | $4,705.30 | $4,705.30 |
Aetna
| Professional | 50 | $98.88 | $148.32 | $897.15 |
Kaiser Permanente
| Professional | $199.58 | $292.83 | $441.74 |