| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.12 | $77.12 | $77.12 | |
Aetna
| Professional | $43.37 | $77.12 | $87.73 | |
Cigna
| Professional | $65.77 | $65.77 | $65.77 | |
Kaiser Permanente
| Professional | $51.04 | $62.82 | $163.43 | |
United
| Professional | $71.95 | $179.90 | $179.90 |