| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $82.81 | $82.81 | $82.81 | |
Aetna
| Professional | $82.81 | $82.81 | $82.81 | |
Kaiser Permanente
| Professional | $189.69 | $189.69 | $189.69 | |
United
| Professional | $41.55 | $68.43 | $192.40 |