| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $114.82 | $114.82 | $114.82 | |
Aetna
| Professional | $95.50 | $112.20 | $138.04 | |
Cigna
| Professional | $107.15 | $107.15 | $107.15 | |
Kaiser Permanente
| Professional | $85.11 | $97.72 | $269.15 | |
United
| Professional | $97.72 | $154.88 | $281.84 |