| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $22.91 | $22.91 | $22.91 | |
Cigna
| Facility | $100.00 | $114.82 | $117.49 | |
Cigna
| Professional | $16.22 | $16.22 | $100.00 | |
Kaiser Permanente
| Professional | $89.13 | $102.33 | $102.33 |