| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $210.00 | $222.00 | |
Aetna
| Professional | $30.00 | $30.00 | $160.00 | |
Cigna
| Professional | $49.01 | $72.00 | $99.87 | |
Kaiser Permanente
| Professional | $76.00 | $76.00 | $76.00 |