| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,080.00 | $5,076.00 | $6,780.62 | |
Aetna
| Facility | 50 | $4,581.00 | $7,791.00 | $8,785.50 |
Kaiser Permanente
| Professional | $1,052.45 | $2,186.17 | $2,186.17 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |