| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $60.26 | $60.26 | $60.26 | |
Aetna
| Professional | $28.84 | $28.84 | $37.15 | |
Kaiser Permanente
| Professional | $676.08 | $676.08 | $676.08 | |
University Health Alliance
| Professional | $208.93 | $208.93 | $257.04 |