| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $91.12 | $91.12 | $171.00 | |
Cigna
| Facility | $123.40 | $123.40 | $123.40 | |
Cigna
| Professional | $73.70 | $157.63 | $509.81 | |
Kaiser Permanente
| Professional | $2,900.00 | $2,900.00 | $2,900.00 |