| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $242.54 | $242.54 | $242.54 | |
Aetna
| Professional | $69.13 | $178.42 | $216.84 | |
Cigna
| Professional | $20.93 | $20.93 | $20.93 | |
Kaiser Permanente
| Professional | $670.00 | $670.00 | $670.00 |