| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $630.00 | $666.00 | |
Aetna
| Professional | $30.00 | $30.00 | $480.00 | |
Kaiser Permanente
| Professional | $422.46 | $422.46 | $456.00 | |
United
| Professional | $46.00 | $70.00 | $111.59 |