| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $212.85 | $232.96 | $6,668.75 | |
Aetna
| Facility | 50 | $0.98 | $1,365.68 | $8,845.37 |
Cigna
| Facility | $1,698.07 | $1,698.07 | $1,698.07 | |
Kaiser Permanente
| Professional | $187.09 | $248.83 | $393.53 |