| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,823.00 | $6,823.00 | $6,823.00 | |
Cigna
| Facility | $6,823.00 | $6,823.00 | $6,823.00 | |
Kaiser Permanente
| Facility | $110.00 | $280.00 | $2,900.00 | |
University Health Alliance
| Facility | $110.00 | $110.00 | $110.00 |