| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.86 | $63.86 | $63.86 | |
Aetna
| Professional | $63.86 | $63.86 | $63.86 | |
Cigna
| Professional | $41.25 | $41.25 | $41.25 | |
Kaiser Permanente
| Professional | $90.47 | $90.47 | $286.41 | |
United
| Professional | $57.06 | $95.45 | $143.41 |