| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $129.32 | $146.56 | $188.10 | |
Aetna
| Professional | $83.08 | $83.08 | $83.08 | |
Cigna
| Professional | $188.10 | $188.10 | $188.10 | |
HMSA
| Professional | $147.72 | $177.13 | $195.94 | |
Kaiser Permanente
| Professional | $172.43 | $188.10 | $219.45 | |
United
| Professional | $156.75 | $188.10 | $235.13 |