| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.20 | $208.93 | $223.87 | |
Aetna
| Professional | $30.20 | $79.43 | $223.87 | |
Cigna
| Professional | $48.98 | $69.18 | $100.00 | |
Kaiser Permanente
| Professional | $75.86 | $75.86 | $75.86 |