| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $52.48 | $60.26 | $70.79 | |
Aetna
| Professional | $53.70 | $70.79 | $114.82 | |
Aetna
| Professional | 25 | $14.45 | $70.79 | $75.86 |
Kaiser Permanente
| Professional | $134.90 | $134.90 | $134.90 | |
United
| Professional | $47.86 | $123.03 | $165.96 |