| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $104.38 | $116.58 | $199.37 | |
Cigna
| Facility | $210.68 | $210.68 | $210.68 | |
Cigna
| Professional | $153.80 | $153.80 | $210.68 | |
Kaiser Permanente
| Professional | $206.81 | $254.09 | $353.00 | |
United
| Professional | $129.96 | $174.23 | $280.98 | |
Wellpoint
| Professional | $183.74 | $183.74 | $243.65 |