| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $60.26 | $60.26 | $60.26 | |
Aetna
| Professional | $30.20 | $61.66 | $114.82 | |
Cigna
| Facility | $309.03 | $309.03 | $309.03 | |
Cigna
| Professional | $53.70 | $85.11 | $194.98 | |
Kaiser Permanente
| Professional | $158.49 | $234.42 | $309.03 |