| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $15,821.91 | $31,954.44 | $38,289.01 | |
Aetna
| Professional | $15,821.91 | $15,821.91 | $15,821.91 | |
Cigna
| Professional | $16,087.50 | $16,087.50 | $16,087.50 | |
Kaiser Permanente
| Professional | $42,866.00 | $42,866.00 | $42,866.00 |