| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $2,747.00 | $2,747.00 | |
Aetna
| Professional | $72.37 | $79.31 | $79.31 | |
Kaiser Permanente
| Professional | $35.93 | $72.84 | $89.28 | |
United
| Professional | $78.88 | $128.60 | $129.62 |