| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $27.48 | $27.48 | $27.48 | |
Aetna
| Professional | $27.48 | $27.48 | $76.06 | |
Kaiser Permanente
| Professional | $18.30 | $71.92 | $71.92 | |
United
| Professional | $55.24 | $71.28 | $267.63 |