| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $59.97 | $59.97 | $59.97 | |
Aetna
| Professional | $59.97 | $59.97 | $59.97 | |
Cigna
| Professional | $101.53 | $101.53 | $101.53 | |
Kaiser Permanente
| Professional | $84.96 | $84.96 | $268.97 | |
United
| Professional | $53.59 | $89.63 | $144.54 |