| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $33.11 | $33.11 | $33.11 | |
Aetna
| Professional | $16.98 | $33.11 | $169.82 | |
Kaiser Permanente
| Professional | $43.65 | $43.65 | $43.65 | |
United
| Facility | $51.29 | $51.29 | $51.29 | |
United
| Professional | $11.48 | $56.23 | $75.86 |