| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $5,685.80 | $6,996.00 | |
Aetna
| Facility | 50 | $8,863.50 | $8,863.50 | $8,863.50 |
Kaiser Permanente
| Professional | $1,294.82 | $2,695.56 | $2,695.56 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |