| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40,834.39 | $40,834.39 | $40,834.39 | |
Aetna
| Professional | $26,263.27 | $40,834.39 | $40,834.39 | |
Cigna
| Professional | $38,437.90 | $38,437.90 | $38,437.90 | |
Kaiser Permanente
| Professional | $51,208.33 | $110,916.80 | $110,916.80 |