| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $200.63 | $200.63 | $200.63 | |
Aetna
| Professional | $171.00 | $219.78 | $275.00 | |
Kaiser Permanente
| Professional | $228.27 | $273.92 | $353.91 | |
United
| Professional | $108.31 | $231.58 | $418.04 |