| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $395.72 | $395.72 | $395.72 | |
Aetna
| Professional | $21.00 | $438.83 | $552.45 | |
Kaiser Permanente
| Professional | $44.11 | $52.06 | $166.94 | |
United
| Professional | $141.10 | $969.77 | $1,552.10 |