| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,818.38 | $11,220.18 | $11,220.18 | |
Aetna
| Facility | 50 | $10,232.93 | $10,232.93 | $10,232.93 |
Kaiser Permanente
| Professional | $630.96 | $691.83 | $870.96 | |
United
| Facility | $3,019.95 | $3,019.95 | $3,019.95 |