| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $88.28 | $100.05 | $128.40 | |
Aetna
| Professional | $56.71 | $56.71 | $56.71 | |
Cigna
| Professional | $128.40 | $128.40 | $128.40 | |
HMSA
| Professional | $100.84 | $120.91 | $133.75 | |
Kaiser Permanente
| Professional | $117.70 | $128.40 | $149.80 | |
United
| Professional | $107.00 | $128.40 | $160.50 |