| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.78 | $25.78 | $25.78 | |
Cigna
| Facility | $330.00 | $339.05 | $1,490.90 | |
Kaiser Permanente
| Professional | $448.66 | $578.77 | $913.08 | |
United
| Facility | $215.00 | $215.00 | $471.00 |