| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $190.56 | $190.56 | $190.56 | |
Aetna
| Professional | $190.56 | $190.56 | $190.56 | |
Kaiser Permanente
| Professional | $415.73 | $415.73 | $415.73 | |
United
| Professional | $102.68 | $327.62 | $526.02 |