| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $776.25 | $5,495.41 | $8,912.51 | |
Aetna
| Facility | 50 | $2,884.03 | $4,570.88 | $8,128.31 |
Kaiser Permanente
| Professional | $549.54 | $602.56 | $1,148.15 | |
United
| Facility | $1,230.27 | $1,230.27 | $2,884.03 |