| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $239.88 | $239.88 | $398.11 | |
Aetna
| Professional | $239.88 | $239.88 | $707.95 | |
Kaiser Permanente
| Professional | $758.58 | $758.58 | $758.58 | |
Molina
| Professional | $44.67 | $50.12 | $64.57 |