| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.98 | $636.32 | $5,557.59 | |
Aetna
| Facility | 50 | $1,323.42 | $2,121.52 | $4,427.17 |
Cigna
| Facility | $1,621.87 | $1,621.87 | $1,621.87 | |
Kaiser Permanente
| Professional | $473.19 | $629.34 | $1,002.77 |