| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $60.16 | $60.16 | $60.16 | |
Aetna
| Professional | $60.16 | $60.16 | $60.16 | |
Kaiser Permanente
| Professional | $131.52 | $131.52 | $131.52 | |
United
| Professional | $50.69 | $96.64 | $130.59 |