| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $90.00 | $90.00 | $90.00 | |
Aetna
| Professional | $90.00 | $90.00 | $90.00 | |
Anthem BCBS
| Professional | $142.50 | $150.00 | $150.00 | |
Cigna
| Facility | $124.38 | $124.38 | $151.56 | |
Cigna
| Professional | $90.80 | $90.80 | $90.80 | |
Kaiser Permanente
| Professional | $637.00 | $678.00 | $678.00 |