| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $221.71 | $221.71 | $221.71 | |
Aetna
| Professional | $194.35 | $221.71 | $221.71 | |
Cigna
| Professional | $216.38 | $216.38 | $216.38 | |
Kaiser Permanente
| Professional | $288.27 | $624.38 | $624.38 | |
United
| Professional | $254.57 | $254.57 | $412.60 |