| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.15 | $537.03 | $2,570.40 | |
Aetna
| Professional | $114.82 | $120.23 | $123.03 | |
Anthem BCBS
| Professional | $42.66 | $44.67 | $44.67 | |
Cigna
| Facility | $123.03 | $123.03 | $123.03 | |
Kaiser Permanente
| Professional | $100.00 | $123.03 | $190.55 |