| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $147.91 | $147.91 | $162.18 | |
Cigna
| Professional | $147.91 | $147.91 | $147.91 | |
HMSA
| Professional | $138.04 | $138.04 | $138.04 | |
Kaiser Permanente
| Professional | $162.18 | $177.83 | $208.93 | |
United
| Professional | $147.91 | $162.18 | $223.87 |