| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $627.00 | $710.60 | $912.00 | |
Aetna
| Professional | $402.80 | $402.80 | $402.80 | |
Cigna
| Professional | $912.00 | $912.00 | $912.00 | |
HMSA
| Professional | $179.36 | $179.36 | $179.36 | |
Kaiser Permanente
| Professional | $836.00 | $912.00 | $1,064.00 | |
United
| Professional | $912.00 | $912.00 | $1,140.00 |