| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $5,754.40 | $5,754.40 | |
Cigna
| Facility | $5,754.40 | $5,754.40 | $5,754.40 | |
Kaiser Permanente
| Professional | $223.87 | $257.04 | $467.74 | |
United
| Facility | $2,238.72 | $2,238.72 | $2,238.72 |