| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.00 | $2.00 | $2.00 | |
Aetna
| Professional | $2.00 | $2.00 | $2.00 | |
Cigna
| Professional | $14.13 | $14.13 | $64.57 | |
Kaiser Permanente
| Professional | $28.84 | $28.84 | $28.84 | |
United
| Facility | $42.66 | $42.66 | $42.66 | |
United
| Professional | $33.88 | $42.66 | $58.88 |