| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $49.49 | $49.49 | $49.49 | |
Aetna
| Professional | $71.22 | $125.67 | $270.55 | |
Cigna
| Professional | $80.53 | $125.83 | $192.02 | |
HMSA
| Professional | $128.86 | $144.76 | $166.50 | |
Kaiser Permanente
| Professional | $670.00 | $670.00 | $670.00 | |
United
| Professional | $104.28 | $152.18 | $192.74 | |
University Health Alliance
| Professional | $61.98 | $116.52 | $285.75 |