| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $155.57 | $176.31 | $226.28 | |
Aetna
| Professional | $139.11 | $139.11 | $139.11 | |
Cigna
| Professional | $142.52 | $226.28 | $226.28 | |
HMSA
| Professional | $310.20 | $366.04 | $426.53 | |
Kaiser Permanente
| Professional | $207.43 | $226.28 | $264.00 | |
United
| Professional | $226.28 | $282.86 | $348.97 | |
University Health Alliance
| Professional | $211.20 | $324.01 | $452.11 |