| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $97.72 | $97.72 | $97.72 | |
Aetna
| Professional | $85.11 | $128.82 | $371.54 | |
Cigna
| Facility | $169.82 | $169.82 | $169.82 | |
Cigna
| Professional | $85.11 | $138.04 | $331.13 | |
Kaiser Permanente
| Professional | $112.20 | $128.82 | $173.78 |