| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.20 | $630.96 | $660.69 | |
Aetna
| Professional | $30.20 | $57.54 | $645.65 | |
Kaiser Permanente
| Professional | $251.19 | $426.58 | $457.09 | |
United
| Professional | $45.71 | $67.61 | $100.00 |