| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $27.49 | $128.00 | $412.35 | |
Aetna
| Professional | $74.02 | $87.35 | $87.35 | |
Cigna
| Professional | $87.12 | $87.12 | $131.97 | |
Kaiser Permanente
| Professional | $168.00 | $168.00 | $168.00 |