| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.98 | $1,586.70 | $9,500.48 | |
Aetna
| Facility | 50 | $5,424.34 | $5,424.34 | $5,424.34 |
Cigna
| Facility | $2,828.59 | $2,828.59 | $2,828.59 | |
Kaiser Permanente
| Professional | $834.22 | $1,109.51 | $1,786.94 |