| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $97.63 | $97.63 | $97.63 | |
Aetna
| Professional | $93.89 | $105.80 | $261.64 | |
Cigna
| Professional | $88.40 | $166.74 | $338.09 | |
Kaiser Permanente
| Professional | $110.88 | $135.52 | $189.99 |