| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $11.22 | $138.04 | $371.54 | |
Aetna
| Facility | 25 | $114.82 | $181.97 | $302.00 |
Kaiser Permanente
| Professional | $10.96 | $13.80 | $33.11 | |
United
| Facility | $17.38 | $17.38 | $17.38 |