| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,018.00 | $2,036.00 | $4,100.00 | |
Aetna
| Facility | 50 | $1,735.50 | $2,036.00 | $3,854.00 |
Kaiser Permanente
| Professional | $842.93 | $1,745.50 | $1,745.50 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |