| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.22 | $163.44 | $209.77 | |
Aetna
| Professional | $92.65 | $92.65 | $92.65 | |
Cigna
| Professional | $209.77 | $209.77 | $209.77 | |
HMSA
| Professional | $176.40 | $208.15 | $242.55 | |
Kaiser Permanente
| Professional | $192.29 | $209.77 | $244.73 | |
United
| Professional | $174.81 | $209.77 | $262.22 |