| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.71 | $45.71 | $45.71 | |
Aetna
| Professional | $28.84 | $45.71 | $45.71 | |
Cigna
| Facility | $46.77 | $46.77 | $46.77 | |
Kaiser Permanente
| Professional | $52.48 | $52.48 | $52.48 | |
United
| Professional | $45.71 | $45.71 | $74.13 |