| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $540.97 | $540.97 | $540.97 | |
Aetna
| Professional | $540.97 | $540.97 | $540.97 | |
Kaiser Permanente
| Professional | $1,113.60 | $1,113.60 | $1,113.60 | |
United
| Professional | $364.87 | $568.20 | $1,693.49 |