| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $165.77 | $253.82 | $253.82 | |
Cigna
| Facility | $230.27 | $230.27 | $230.27 | |
Cigna
| Professional | $175.00 | $175.00 | $318.85 | |
HMSA
| Professional | $289.86 | $303.52 | $303.52 | |
Kaiser Permanente
| Professional | $173.92 | $289.86 | $405.80 | |
United
| Professional | $202.02 | $230.27 | $361.53 | |
University Health Alliance
| Professional | $202.02 | $241.50 | $275.89 |