| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.10 | $87.10 | $87.10 | |
Aetna
| Professional | $85.11 | $87.10 | $234.42 | |
Cigna
| Facility | $89.13 | $89.13 | $89.13 | |
Kaiser Permanente
| Professional | $186.21 | $186.21 | $186.21 | |
United
| Professional | $87.10 | $87.10 | $141.25 |