| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $18.39 | $18.39 | $18.39 | |
Cigna
| Facility | $58.75 | $58.75 | $58.75 | |
Cigna
| Professional | $30.91 | $30.91 | $81.34 | |
HMSA
| Professional | $73.95 | $77.43 | $77.43 | |
Kaiser Permanente
| Professional | $44.37 | $73.95 | $103.53 | |
United
| Professional | $28.98 | $58.75 | $81.34 | |
University Health Alliance
| Professional | $32.35 | $59.58 | $70.39 |