| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $289.80 | $431.75 | |
Kaiser Permanente
| Professional | $5.00 | $355.00 | $450.00 | |
Medcost
| Facility | $48.03 | $2,460.00 | $3,184.32 | |
Sentara
| Facility | $23.16 | $64.00 | $92.88 |