| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.89 | $30.89 | $30.89 | |
Aetna
| Professional | $30.89 | $42.63 | $42.63 | |
Kaiser Permanente
| Professional | $84.48 | $504.78 | $688.34 | |
United
| Professional | $27.61 | $37.79 | $68.36 |