| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $33.71 | $33.71 | $33.71 | |
Aetna
| Professional | $33.71 | $33.71 | $33.71 | |
Cigna
| Professional | $27.97 | $27.97 | $27.97 | |
Kaiser Permanente
| Professional | $31.91 | $71.06 | $71.06 | |
United
| Facility | $165.00 | $442.00 | $5,940.00 | |
United
| Professional | $24.26 | $40.35 | $89.99 |