| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.78 | $173.78 | $173.78 | |
Aetna
| Professional | $157.66 | $173.78 | $173.78 | |
Cigna
| Professional | $149.69 | $149.69 | $149.69 | |
Kaiser Permanente
| Professional | $184.23 | $417.76 | $417.76 | |
United
| Professional | $158.37 | $468.01 | $592.28 |