| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $20.83 | $20.83 | $20.83 | |
Cigna
| Facility | $72.00 | $180.25 | $180.25 | |
Kaiser Permanente
| Professional | $113.00 | $118.00 | $128.00 | |
Wellpoint
| Professional | $14.50 | $14.50 | $14.50 |