| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $201.56 | $201.56 | $201.56 | |
Cigna
| Professional | $99.97 | $99.97 | $99.97 | |
HMSA
| Professional | $144.29 | $144.29 | $144.29 | |
Kaiser Permanente
| Professional | $109.96 | $119.96 | $139.94 | |
United
| Professional | $99.97 | $118.60 | $149.96 | |
University Health Alliance
| Professional | $100.75 | $120.98 | $129.97 |