| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $626.22 | $709.71 | $910.86 | |
Aetna
| Professional | $402.30 | $402.30 | $402.30 | |
Cigna
| Professional | $910.86 | $910.86 | $910.86 | |
HMSA
| Professional | $759.05 | $794.82 | $948.81 | |
Kaiser Permanente
| Professional | $834.96 | $910.86 | $1,062.67 | |
United
| Professional | $759.05 | $910.86 | $1,138.58 |