| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,025.20 | $4,025.20 | $4,025.20 | |
Cigna
| Facility | $330.00 | $339.05 | $451.23 | |
Kaiser Permanente
| Professional | $75.04 | $98.52 | $125.49 | |
United
| Facility | $123.00 | $123.00 | $158.00 |