| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.71 | $104.71 | $104.71 | |
Aetna
| Professional | $104.71 | $104.71 | $303.82 | |
Cigna
| Professional | $108.13 | $108.13 | $108.13 | |
Kaiser Permanente
| Professional | $81.69 | $97.76 | $216.26 | |
United
| Professional | $290.64 | $478.59 | $845.26 |