| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,888.44 | $5,888.44 | $5,888.44 | |
Aetna
| Professional | $1,548.82 | $1,548.82 | $1,548.82 | |
Cigna
| Professional | $660.69 | $660.69 | $660.69 | |
Kaiser Permanente
| Professional | $100.00 | $100.00 | $100.00 |