| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $316.23 | $316.23 | $316.23 | |
Aetna
| Professional | $125.89 | $316.23 | $660.69 | |
Kaiser Permanente
| Professional | $478.63 | $478.63 | $478.63 | |
United
| Professional | $109.65 | $537.03 | $812.83 |