| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.34 | $99.97 | $235.32 | |
Aetna
| Professional | $74.02 | $87.35 | $87.35 | |
Cigna
| Professional | $87.12 | $87.12 | $87.12 | |
Kaiser Permanente
| Professional | $144.00 | $168.00 | $180.00 | |
Wellpoint
| Professional | $16.82 | $16.82 | $16.82 |