| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.99 | $867.70 | $4,073.10 | |
Aetna
| Facility | 50 | $184.50 | $2,434.64 | $4,599.57 |
Cigna
| Facility | $1,621.87 | $1,621.87 | $1,621.87 | |
Kaiser Permanente
| Professional | $751.64 | $999.68 | $1,607.45 |