| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $53.95 | $53.95 | $53.95 | |
Aetna
| Professional | $53.95 | $53.95 | $53.95 | |
Cigna
| Facility | $53.95 | $53.95 | $53.95 | |
Kaiser Permanente
| Professional | $67.44 | $67.44 | $67.44 | |
United
| Professional | $48.13 | $52.89 | $85.72 |