| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $123.75 | $140.25 | $180.00 | |
Aetna
| Professional | $79.50 | $79.50 | $79.50 | |
Cigna
| Professional | $180.00 | $180.00 | $180.00 | |
HMSA
| Professional | $35.40 | $35.40 | $35.40 | |
Kaiser Permanente
| Professional | $165.00 | $180.00 | $210.00 | |
United
| Professional | $150.00 | $180.00 | $225.00 |