| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $55.86 | $162.03 | $165.00 | |
Aetna
| Professional | $33.00 | $38.89 | $105.84 | |
Cigna
| Professional | $14.86 | $14.86 | $14.86 | |
Kaiser Permanente
| Professional | $35.81 | $42.13 | $60.67 | |
Wellpoint
| Professional | $35.28 | $35.28 | $35.28 |