| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $320.33 | $320.33 | $320.33 | |
Aetna
| Professional | $320.33 | $320.33 | $320.33 | |
Kaiser Permanente
| Professional | $698.17 | $698.17 | $698.17 | |
United
| Professional | $200.65 | $232.25 | $826.85 |