| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $64.57 | $64.57 | $128.82 | |
Cigna
| Professional | $64.57 | $64.57 | $85.11 | |
HMSA
| Professional | $81.28 | $81.28 | $81.28 | |
Kaiser Permanente
| Professional | $64.57 | $77.62 | $97.72 | |
United
| Professional | $64.57 | $69.18 | $100.00 |