| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.99 | $1,608.84 | $4,976.17 | |
Aetna
| Facility | 50 | $2,575.98 | $5,170.31 | $8,072.21 |
Cigna
| Facility | $3,347.40 | $3,347.40 | $3,347.40 | |
Kaiser Permanente
| Professional | $801.91 | $1,066.54 | $1,720.23 |