| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.24 | $63.24 | $63.24 | |
Cigna
| Facility | $63.24 | $63.24 | $63.24 | |
Cigna
| Professional | $55.08 | $55.08 | $55.08 | |
HMSA
| Professional | $51.31 | $51.31 | $51.31 | |
United
| Professional | $52.06 | $54.00 | $81.00 | |
University Health Alliance
| Professional | $12.97 | $31.69 | $40.88 |