| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $229.03 | $229.03 | $229.03 | |
Aetna
| Professional | $206.56 | $229.03 | $229.03 | |
Kaiser Permanente
| Professional | $186.75 | $403.80 | $403.80 | |
United
| Professional | $181.45 | $474.89 | $641.74 |