| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $47.23 | $47.23 | $47.23 | |
Aetna
| Professional | $47.23 | $47.23 | $47.23 | |
Cigna
| Professional | $54.79 | $54.79 | $54.79 | |
Kaiser Permanente
| Professional | $66.92 | $66.92 | $211.83 | |
United
| Professional | $42.20 | $70.59 | $106.06 |