| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $44.18 | $44.18 | $44.18 | |
Aetna
| Professional | $44.18 | $44.18 | $44.18 | |
Kaiser Permanente
| Professional | $96.39 | $96.39 | $96.39 | |
United
| Professional | $40.18 | $98.91 | $101.73 |