| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $89.10 | $89.10 | $89.10 | |
Aetna
| Professional | $68.11 | $89.10 | $106.95 | |
Kaiser Permanente
| Professional | $93.94 | $107.36 | $141.46 | |
United
| Professional | $70.77 | $89.15 | $158.37 |