| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $420.08 | $2,152.80 | $3,111.50 | |
Aetna
| Facility | 50 | $4,457.97 | $4,457.97 | $4,457.97 |
Cigna
| Facility | $2,659.03 | $2,659.03 | $2,659.03 | |
Kaiser Permanente
| Professional | $397.07 | $528.10 | $845.59 |