| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $160.06 | $160.07 | $166.53 | |
Cigna
| Facility | $358.12 | $358.12 | $358.12 | |
Cigna
| Professional | $175.81 | $175.81 | $495.88 | |
HMSA
| Professional | $450.80 | $472.04 | $472.04 | |
Kaiser Permanente
| Professional | $270.48 | $450.80 | $631.12 | |
United
| Professional | $203.46 | $358.12 | $495.88 | |
University Health Alliance
| Professional | $197.16 | $363.14 | $429.07 |