| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $114.43 | $114.43 | $114.43 | |
Aetna
| Professional | $102.62 | $114.43 | $131.18 | |
Cigna
| Professional | $107.43 | $107.43 | $107.43 | |
Kaiser Permanente
| Professional | $83.23 | $102.44 | $267.85 | |
United
| Professional | $96.18 | $153.80 | $289.04 |