| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.48 | $76.48 | $76.48 | |
Aetna
| Professional | $76.48 | $76.48 | $76.48 | |
Kaiser Permanente
| Professional | $169.81 | $169.81 | $169.81 | |
United
| Professional | $50.59 | $82.81 | $154.99 |