| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.00 | $50.00 | $50.00 | |
Aetna
| Professional | $50.00 | $50.00 | $50.00 | |
Anthem BCBS
| Professional | $161.50 | $170.00 | $170.00 | |
Cigna
| Facility | $187.52 | $187.52 | $187.52 | |
Cigna
| Professional | $100.82 | $100.82 | $100.82 | |
Kaiser Permanente
| Professional | $1.00 | $1.00 | $1.00 |