| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.95 | $106.95 | $106.95 | |
Aetna
| Professional | $89.10 | $106.95 | $106.95 | |
Kaiser Permanente
| Professional | $96.31 | $111.52 | $220.24 | |
United
| Professional | $70.77 | $87.98 | $225.69 |