| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $213.80 | $213.80 | $213.80 | |
Aetna
| Professional | $213.80 | $213.80 | $269.15 | |
Kaiser Permanente
| Professional | $269.15 | $269.15 | $269.15 | |
United
| Professional | $208.93 | $245.47 | $309.03 |