| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,764.30 | $2,764.30 | $2,764.30 | |
Aetna
| Facility | 50 | $76.84 | $76.84 | $76.84 |
Cigna
| Facility | $2,558.05 | $2,558.05 | $2,558.05 | |
Kaiser Permanente
| Professional | $241.23 | $320.83 | $511.29 |