| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $168.94 | $168.94 | $168.94 | |
Aetna
| Professional | $101.50 | $168.94 | $201.00 | |
Cigna
| Professional | $141.06 | $141.06 | $141.06 | |
Kaiser Permanente
| Professional | $109.12 | $134.30 | $351.17 | |
United
| Professional | $145.16 | $271.52 | $417.40 |