| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $51.29 | $51.29 | $51.29 | |
Aetna
| Professional | $93.33 | $181.97 | $181.97 | |
Kaiser Permanente
| Professional | $7.76 | $7.76 | $7.76 | |
United
| Professional | $112.20 | $112.20 | $112.20 |