| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.71 | $164.00 | $210.48 | |
Aetna
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Professional | $210.48 | $210.48 | $210.48 | |
HMSA
| Professional | $180.60 | $213.11 | $248.33 | |
Kaiser Permanente
| Professional | $192.94 | $210.48 | $245.56 | |
United
| Professional | $179.25 | $210.48 | $263.10 | |
University Health Alliance
| Professional | $125.58 | $206.97 | $394.65 |