| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.20 | $112.20 | $112.20 | |
Aetna
| Professional | $114.82 | $134.90 | $186.21 | |
Cigna
| Professional | $302.00 | $302.00 | $363.08 | |
Kaiser Permanente
| Professional | $676.08 | $676.08 | $676.08 |