| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $74.98 | $74.98 | $74.98 | |
Aetna
| Professional | $61.60 | $71.68 | $74.98 | |
Cigna
| Professional | $112.52 | $112.52 | $112.52 | |
Kaiser Permanente
| Professional | $75.51 | $163.63 | $163.63 | |
United
| Professional | $56.48 | $96.30 | $197.50 |