| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $214.23 | $214.23 | $214.23 | |
Aetna
| Professional | $214.23 | $214.23 | $214.23 | |
Kaiser Permanente
| Professional | $442.07 | $442.07 | $442.07 | |
United
| Professional | $144.61 | $225.15 | $672.27 |