| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $163.65 | $967.00 | $1,584.36 | |
Aetna
| Facility | 25 | $992.05 | $1,569.62 | $6,327.87 |
Aetna
| Professional | 25 | $166.92 | $401.49 | $760.88 |
Kaiser Permanente
| Professional | $174.30 | $236.38 | $293.55 |