| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $163.96 | $185.82 | $238.49 | |
Aetna
| Professional | $87.73 | $87.73 | $87.73 | |
Cigna
| Professional | $238.49 | $238.49 | $238.49 | |
HMSA
| Professional | $48.39 | $48.39 | $48.39 | |
Kaiser Permanente
| Professional | $218.61 | $238.49 | $278.24 | |
United
| Professional | $165.52 | $223.44 | $238.49 |