| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $162.18 | $162.18 | $162.18 | |
Aetna
| Professional | $158.49 | $162.18 | $204.17 | |
Kaiser Permanente
| Professional | $213.80 | $213.80 | $213.80 | |
United
| Professional | $158.49 | $186.21 | $229.09 |