| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $49.67 | $4,747.18 | $8,237.57 | |
Aetna
| Facility | 22 | $25,669.26 | $25,669.26 | $25,669.26 |
Cigna
| Facility | $3,016.21 | $3,016.21 | $3,016.21 | |
Kaiser Permanente
| Professional | $742.37 | $987.35 | $1,586.75 |