| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $43.65 | $1,023.29 | $1,023.29 | |
Aetna
| Facility | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
Cigna
| Facility | $602.56 | $602.56 | $630.96 | |
Kaiser Permanente
| Professional | $162.18 | $186.21 | $354.81 | |
United
| Facility | $89.13 | $89.13 | $128.82 |