| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $98.48 | $417.31 | $987.71 | |
Aetna
| Facility | 25 | $140.21 | $847.87 | $987.71 |
Cigna
| Facility | $111.66 | $111.66 | $111.66 | |
Kaiser Permanente
| Professional | $82.37 | $122.52 | $434.96 | |
Medcost
| Facility | $107.99 | $160.78 | $240.76 | |
Sentara
| Facility | $109.46 | $160.27 | $313.70 |