| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $257.49 | $257.49 | $257.49 | |
Aetna
| Professional | $257.49 | $257.49 | $257.49 | |
Kaiser Permanente
| Professional | $561.72 | $561.72 | $561.72 | |
United
| Professional | $160.28 | $447.55 | $710.87 |