| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.51 | $28.68 | $319.13 | |
Aetna
| Professional | $22.58 | $22.58 | $22.58 | |
Cigna
| Professional | $15.31 | $31.28 | $31.28 | |
HMSA
| Professional | $31.47 | $39.40 | $48.55 | |
Kaiser Permanente
| Professional | $26.07 | $31.28 | $39.11 | |
United
| Professional | $10.95 | $31.28 | $39.11 | |
University Health Alliance
| Professional | $28.39 | $35.61 | $50.02 |