| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $116.58 | $116.58 | $116.58 | |
Aetna
| Professional | $116.58 | $116.58 | $116.58 | |
Cigna
| Professional | $153.80 | $153.80 | $153.80 | |
Kaiser Permanente
| Professional | $165.16 | $165.16 | $522.83 | |
United
| Professional | $104.17 | $174.23 | $261.79 |