| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $2,747.00 | $2,747.00 | |
Aetna
| Professional | $49.09 | $53.69 | $53.69 | |
Kaiser Permanente
| Professional | $58.29 | $68.58 | $80.01 | |
United
| Professional | $53.47 | $87.42 | $87.84 |