| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $93.19 | $93.19 | $93.19 | |
Aetna
| Professional | $57.31 | $93.19 | $107.15 | |
Cigna
| Professional | $96.75 | $96.75 | $96.75 | |
Kaiser Permanente
| Professional | $52.22 | $140.74 | $140.74 | |
United
| Professional | $37.95 | $75.81 | $139.28 |