| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.18 | $73.87 | $94.80 | |
Aetna
| Professional | $41.87 | $41.87 | $41.87 | |
Cigna
| Professional | $94.80 | $94.80 | $94.80 | |
HMSA
| Professional | $79.00 | $79.00 | $82.72 | |
Kaiser Permanente
| Professional | $86.90 | $94.80 | $110.60 | |
United
| Professional | $79.00 | $94.80 | $118.50 |