| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.99 | $112.99 | $112.99 | |
Cigna
| Facility | $112.34 | $112.34 | $112.34 | |
Cigna
| Professional | $470.87 | $470.87 | $470.87 | |
Kaiser Permanente
| Professional | $64.06 | $69.89 | $81.54 | |
United
| Professional | $85.68 | $123.89 | $124.87 |