| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $123.00 | $130.69 | $130.69 | |
Cigna
| Facility | $130.69 | $130.69 | $130.69 | |
Cigna
| Professional | $130.69 | $130.69 | $130.69 | |
Kaiser Permanente
| Professional | $66.64 | $95.19 | $138.38 | |
United
| Professional | $128.13 | $128.13 | $134.60 |