| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $71.98 | $71.98 | $71.98 | |
Aetna
| Professional | $62.37 | $71.98 | $78.50 | |
Cigna
| Professional | $66.06 | $66.06 | $66.06 | |
Kaiser Permanente
| Professional | $52.04 | $64.05 | $167.47 | |
United
| Professional | $69.31 | $154.91 | $177.86 |