| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.34 | $104.34 | $104.34 | |
Aetna
| Professional | $95.24 | $104.34 | $104.34 | |
Kaiser Permanente
| Professional | $98.42 | $116.42 | $215.67 | |
United
| Professional | $61.33 | $98.57 | $207.63 |