| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.20 | $741.31 | $776.25 | |
Aetna
| Professional | $30.20 | $50.12 | $741.31 | |
Kaiser Permanente
| Professional | $295.12 | $489.78 | $537.03 | |
United
| Professional | $45.71 | $67.61 | $100.00 |