| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $106.45 | $131.72 | $137.68 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $56.76 | $56.76 | $56.76 | |
Kaiser Permanente
| Professional | $118.00 | $128.00 | $128.00 | |
Wellpoint
| Professional | $23.20 | $23.20 | $23.20 |