| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $108.36 | $142.91 | $726.82 | |
Aetna
| Professional | $108.36 | $108.36 | $108.36 | |
Cigna
| Facility | $108.36 | $108.36 | $108.36 | |
Cigna
| Professional | $108.36 | $108.36 | $108.36 | |
Kaiser Permanente
| Professional | $132.60 | $273.72 | $273.72 | |
United
| Professional | $106.24 | $106.24 | $172.19 |