| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.00 | $75.00 | $75.00 | |
Aetna
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Professional | $98.27 | $98.27 | $98.27 | |
Kaiser Permanente
| Professional | $247.00 | $247.00 | $247.00 |