| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $73.01 | $73.01 | $73.01 | |
Aetna
| Professional | $73.01 | $100.75 | $100.75 | |
Kaiser Permanente
| Professional | $58.64 | $71.67 | $129.49 | |
United
| Professional | $64.84 | $87.08 | $153.90 |