| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $93.33 | $112.20 | $138.04 | |
Aetna
| Professional | $61.66 | $89.13 | $112.20 | |
Cigna
| Professional | $138.04 | $138.04 | $138.04 | |
HMSA
| Professional | $120.23 | $151.36 | $151.36 | |
Kaiser Permanente
| Professional | $114.82 | $138.04 | $169.82 | |
United
| Professional | $47.86 | $114.82 | $169.82 |