| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.08 | $112.08 | $112.08 | |
Aetna
| Professional | $62.39 | $112.08 | $119.88 | |
Cigna
| Professional | $92.55 | $92.55 | $92.55 | |
Kaiser Permanente
| Professional | $72.76 | $89.55 | $234.17 | |
United
| Professional | $94.55 | $160.66 | $247.19 |