| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $681.67 | $3,941.92 | $6,972.21 | |
Aetna
| Facility | 50 | $2,910.22 | $4,550.85 | $11,099.68 |
Kaiser Permanente
| Professional | $593.23 | $688.95 | $1,252.64 | |
United
| Facility | $1,236.00 | $1,236.00 | $1,236.00 |