| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $8,677.00 | $13,070.00 | |
Aetna
| Facility | 50 | $8,179.00 | $8,424.00 | $13,015.50 |
Kaiser Permanente
| Professional | $686.32 | $1,420.33 | $1,420.33 | |
United
| Facility | $4,062.00 | $5,185.00 | $19,046.00 |