| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,080.00 | $4,100.00 | $6,150.00 | |
Aetna
| Facility | 50 | $5,578.00 | $7,392.00 | $8,785.50 |
Kaiser Permanente
| Professional | $1,205.83 | $2,496.60 | $2,496.60 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |