| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $255.79 | $255.79 | $255.79 | |
Aetna
| Professional | $230.68 | $255.79 | $255.79 | |
Kaiser Permanente
| Professional | $321.27 | $695.98 | $695.98 | |
United
| Professional | $202.94 | $349.98 | $1,095.51 |