| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $44.67 | $44.67 | $44.67 | |
Cigna
| Facility | $380.19 | $380.19 | $380.19 | |
Cigna
| Professional | $380.19 | $380.19 | $380.19 | |
HMSA
| Professional | $83.18 | $83.18 | $87.10 | |
Kaiser Permanente
| Professional | $83.18 | $83.18 | $83.18 | |
United
| Facility | $489.78 | $489.78 | $489.78 | |
United
| Professional | $4,786.30 | $4,786.30 | $4,786.30 |