| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $156.65 | $156.65 | $156.65 | |
Aetna
| Professional | $154.28 | $156.94 | $169.71 | |
Cigna
| Professional | $164.86 | $164.86 | $164.86 | |
Kaiser Permanente
| Professional | $180.27 | $180.27 | $198.30 | |
United
| Professional | $206.43 | $247.54 | $366.55 |