| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.99 | $2,047.06 | $5,737.99 | |
Aetna
| Facility | 50 | $0.99 | $3,727.02 | $7,426.97 |
Cigna
| Facility | $2,828.59 | $2,828.59 | $2,828.59 | |
Kaiser Permanente
| Professional | $850.56 | $1,097.22 | $1,822.52 |