| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $785.54 | $904.76 | $1,608.85 | |
Aetna
| Facility | 50 | $5,693.41 | $5,693.41 | $8,453.65 |
Cigna
| Facility | $1,621.87 | $1,621.87 | $1,621.87 | |
Kaiser Permanente
| Professional | $681.00 | $878.49 | $1,458.25 |