| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $49.92 | $49.92 | $49.92 | |
Cigna
| Facility | $445.00 | $453.73 | $873.24 | |
Kaiser Permanente
| Professional | $642.04 | $828.24 | $1,084.33 | |
United
| Facility | $520.00 | $520.00 | $733.00 |