| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $9.00 | $26.31 | $26.31 | |
Cigna
| Facility | $115.00 | $115.00 | $115.00 | |
Cigna
| Professional | $145.26 | $145.26 | $145.26 | |
Kaiser Permanente
| Professional | $170.00 | $230.00 | $230.00 | |
Wellpoint
| Professional | $7.25 | $164.64 | $164.64 |