| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $79.73 | $79.73 | $79.73 | |
Cigna
| Facility | $79.73 | $79.73 | $79.73 | |
Cigna
| Professional | $54.00 | $54.00 | $54.00 | |
HMSA
| Professional | $60.43 | $60.43 | $60.43 | |
United
| Professional | $51.04 | $59.29 | $79.41 | |
University Health Alliance
| Professional | $40.38 | $42.10 | $53.57 |