| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.48 | $76.48 | $76.48 | |
Aetna
| Professional | $69.80 | $76.48 | $76.48 | |
Kaiser Permanente
| Professional | $84.29 | $99.66 | $166.72 | |
United
| Professional | $60.52 | $80.81 | $214.76 |