| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $43.65 | $52.48 | $63.10 | |
Aetna
| Professional | $28.18 | $40.74 | $51.29 | |
Cigna
| Professional | $63.10 | $63.10 | $63.10 | |
HMSA
| Professional | $52.48 | $61.66 | $66.07 | |
Kaiser Permanente
| Professional | $52.48 | $63.10 | $79.43 | |
United
| Professional | $22.39 | $52.48 | $79.43 |