| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $110.66 | $125.41 | $160.96 | |
Aetna
| Professional | $71.09 | $71.09 | $71.09 | |
Cigna
| Professional | $160.96 | $160.96 | $160.96 | |
HMSA
| Professional | $126.41 | $140.44 | $167.66 | |
Kaiser Permanente
| Professional | $147.54 | $160.96 | $187.78 | |
United
| Professional | $134.13 | $160.96 | $201.20 |