| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $127.89 | $127.89 | $127.89 | |
Aetna
| Professional | $71.75 | $127.89 | $143.22 | |
Cigna
| Professional | $107.43 | $107.43 | $107.43 | |
Kaiser Permanente
| Professional | $83.23 | $102.44 | $267.85 | |
United
| Professional | $113.70 | $255.63 | $296.39 |