| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.99 | $1,520.39 | $8,252.92 | |
Aetna
| Facility | 50 | $4,494.51 | $7,990.98 | $13,374.51 |
Cigna
| Facility | $2,828.59 | $2,828.59 | $2,828.59 | |
Kaiser Permanente
| Professional | $1,148.19 | $1,527.09 | $2,461.66 |