| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $549.54 | $2,187.76 | $4,365.16 | |
Aetna
| Facility | 50 | $2,454.71 | $2,454.71 | $2,454.71 |
Kaiser Permanente
| Professional | $489.78 | $602.56 | $1,000.00 | |
United
| Facility | $954.99 | $954.99 | $1,621.81 |