| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $153.00 | $153.00 | $153.00 | |
Aetna
| Professional | $153.00 | $153.00 | $153.00 | |
Cigna
| Facility | $153.00 | $153.00 | $153.00 | |
Cigna
| Professional | $153.00 | $153.00 | $153.00 | |
Kaiser Permanente
| Professional | $153.00 | $162.00 | $162.00 | |
United
| Professional | $180.00 | $180.00 | $291.74 |