| 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 | $2,886.00 | $2,886.00 | $2,886.00 |
Kaiser Permanente
| Professional | $1,207.72 | $1,317.52 | $1,537.10 | |
United
| Facility | $2,912.00 | $2,912.00 | $2,912.00 |