| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $855.21 | $855.21 | $855.21 | |
Cigna
| Facility | $50.00 | $223.26 | $375.07 | |
Cigna
| Facility | 52 | $35.19 | $35.19 | $35.19 |
Cigna
| Facility | 53 | $8.80 | $8.80 | $8.80 |
Kaiser Permanente
| Professional | $38.68 | $47.65 | $80.84 | |
United
| Facility | $71.00 | $100.00 | $550.00 |