| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $618.75 | $701.25 | $900.00 | |
Aetna
| Professional | $397.50 | $397.50 | $397.50 | |
Cigna
| Professional | $900.00 | $900.00 | $900.00 | |
HMSA
| Professional | $706.81 | $847.50 | $937.50 | |
Kaiser Permanente
| Professional | $825.00 | $900.00 | $1,050.00 | |
United
| Professional | $900.00 | $900.00 | $1,125.00 |