| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $2,747.00 | $2,747.00 | |
Aetna
| Professional | $81.59 | $81.59 | $81.59 | |
Cigna
| Professional | $99.76 | $99.76 | $140.83 | |
Kaiser Permanente
| Professional | $76.84 | $120.47 | $142.06 | |
United
| Facility | $1,078.00 | $1,078.00 | $1,078.00 | |
United
| Professional | $99.76 | $131.59 | $169.82 |