| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $166.34 | $166.34 | $166.34 | |
Aetna
| Professional | $166.34 | $166.34 | $166.34 | |
Kaiser Permanente
| Professional | $361.01 | $361.01 | $361.01 | |
United
| Professional | $151.35 | $236.49 | $383.12 |