| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $120.23 | $120.23 | $131.83 | |
Cigna
| Professional | $120.23 | $120.23 | $120.23 | |
HMSA
| Professional | $117.49 | $117.49 | $117.49 | |
Kaiser Permanente
| Professional | $131.83 | $144.54 | $169.82 | |
United
| Professional | $120.23 | $138.04 | $181.97 |