| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $371.54 | $371.54 | $371.54 | |
Aetna
| Professional | $363.08 | $371.54 | $371.54 | |
Cigna
| Facility | $371.54 | $371.54 | $371.54 | |
Kaiser Permanente
| Professional | $15.85 | $15.85 | $15.85 | |
United
| Professional | $371.54 | $407.38 | $602.56 |