| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $100.08 | $138.51 | $212.07 | |
Aetna
| Professional | 25 | $185.78 | $185.78 | $188.59 |
Cigna
| Professional | $147.90 | $147.90 | $195.57 | |
Kaiser Permanente
| Professional | $153.13 | $198.17 | $377.64 | |
United
| Professional | $88.37 | $173.71 | $390.72 |