| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.32 | $112.32 | $112.32 | |
Aetna
| Professional | $78.12 | $112.32 | $112.32 | |
Ambetter
| Professional | $30.56 | $41.29 | $73.79 | |
Cigna
| Professional | $2.00 | $2.00 | $2.00 | |
Kaiser Permanente
| Professional | $266.00 | $266.00 | $378.00 |