| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $525.00 | $525.00 | $525.00 | |
Aetna
| Professional | $32.50 | $53.00 | $525.00 | |
Kaiser Permanente
| Professional | $155.85 | $245.00 | $459.20 | |
United
| Professional | $34.85 | $50.00 | $76.00 | |
University Health Alliance
| Professional | $8.69 | $49.30 | $71.83 |