| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,698.24 | $5,370.32 | $7,079.46 | |
Aetna
| Facility | 50 | $8,912.51 | $8,912.51 | $8,912.51 |
Kaiser Permanente
| Professional | $1,174.90 | $2,454.71 | $2,691.53 | |
United
| Facility | $4,073.80 | $16,218.10 | $33,884.42 |