| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,534.58 | $7,698.34 | $9,932.93 | |
Aetna
| Facility | 22 | $7,970.19 | $7,970.19 | $7,970.19 |
Cigna
| Facility | $5,162.83 | $5,162.83 | $5,162.83 | |
Kaiser Permanente
| Professional | $945.19 | $1,219.30 | $2,016.22 |