| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $507.43 | $563.25 | $3,079.41 | |
Aetna
| Facility | 50 | $0.98 | $1,869.47 | $12,382.04 |
Cigna
| Facility | $2,558.05 | $2,558.05 | $2,558.05 | |
Kaiser Permanente
| Professional | $484.67 | $625.22 | $1,028.30 |