| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $8.00 | $24.46 | $24.46 | |
Cigna
| Facility | $138.00 | $138.00 | $189.00 | |
Cigna
| Professional | $58.98 | $58.98 | $58.98 | |
Kaiser Permanente
| Professional | $113.00 | $128.00 | $128.00 | |
Wellpoint
| Professional | $20.00 | $20.00 | $20.00 |