| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,635.55 | $2,747.00 | $5,484.00 | |
Aetna
| Facility | 50 | $7,909.50 | $7,909.50 | $7,909.50 |
Kaiser Permanente
| Professional | $1,030.69 | $1,124.39 | $1,311.79 | |
United
| Facility | $2,155.00 | $2,155.00 | $2,155.00 |