| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.13 | $23.17 | $23.17 | |
Cigna
| Facility | $114.00 | $114.00 | $117.60 | |
Cigna
| Professional | $16.39 | $16.39 | $16.39 | |
Kaiser Permanente
| Professional | $90.00 | $102.00 | $102.00 | |
Wellpoint
| Professional | $22.00 | $22.00 | $22.00 |