| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $138.99 | $138.99 | $138.99 | |
Aetna
| Professional | $134.43 | $152.24 | $309.88 | |
Kaiser Permanente
| Professional | $141.97 | $183.15 | $444.57 | |
United
| Professional | $202.12 | $254.63 | $457.56 |