| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.15 | $107.15 | $107.15 | |
Aetna
| Professional | $75.86 | $91.20 | $109.65 | |
Cigna
| Professional | $147.91 | $147.91 | $162.18 | |
Kaiser Permanente
| Professional | $138.04 | $151.36 | $186.21 | |
United
| Professional | $125.89 | $125.89 | $151.36 |