| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.60 | $254.94 | $254.94 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $11.30 | $11.30 | $33.00 | |
Kaiser Permanente
| Professional | $456.00 | $456.00 | $626.00 |