| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.50 | $45.50 | $45.50 | |
Aetna
| Professional | $88.47 | $134.44 | $192.63 | |
Cigna
| Professional | $88.13 | $138.09 | $208.27 | |
HMSA
| Professional | $135.25 | $150.28 | $176.64 | |
Kaiser Permanente
| Professional | $670.00 | $670.00 | $670.00 | |
United
| Professional | $111.60 | $160.55 | $204.69 | |
University Health Alliance
| Professional | $61.98 | $116.52 | $304.80 |