| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $33.79 | $33.79 | $33.79 | |
Aetna
| Professional | $25.47 | $33.79 | $33.79 | |
Cigna
| Professional | $155.19 | $155.19 | $155.19 | |
Kaiser Permanente
| Professional | $85.00 | $85.00 | $96.00 | |
Medcost
| Facility | $25.47 | $33.79 | $33.79 |