| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.70 | $1,509.69 | $4,465.59 | |
Aetna
| Facility | 50 | $0.98 | $1,365.68 | $3,401.58 |
Cigna
| Facility | $2,558.05 | $2,558.05 | $2,558.05 | |
Kaiser Permanente
| Professional | $388.68 | $516.94 | $822.86 |