| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $205.70 | $205.70 | $205.70 | |
Aetna
| Professional | $205.70 | $205.70 | $205.70 | |
Cigna
| Facility | $205.70 | $205.70 | $205.70 | |
Cigna
| Professional | $205.70 | $205.70 | $205.70 | |
Kaiser Permanente
| Professional | $91.21 | $197.56 | $197.56 | |
United
| Professional | $220.00 | $220.00 | $356.57 |