| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $165.96 | $165.96 | $165.96 | |
Aetna
| Professional | $138.04 | $158.49 | $177.83 | |
Kaiser Permanente
| Professional | $363.08 | $363.08 | $363.08 | |
United
| Professional | $147.91 | $213.80 | $380.19 |