| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $792.55 | $15,759.36 | $15,759.36 | |
Aetna
| Facility | 50 | $1,137.45 | $1,137.45 | $5,893.49 |
Cigna
| Facility | $1,012.19 | $1,012.19 | $1,012.19 | |
Kaiser Permanente
| Professional | $905.28 | $1,186.67 | $2,120.19 |