| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,157.88 | $2,747.00 | $3,883.00 | |
Aetna
| Facility | 50 | $3,734.00 | $3,734.00 | $3,734.00 |
Kaiser Permanente
| Professional | $845.54 | $922.40 | $1,076.14 | |
United
| Facility | $2,912.00 | $2,912.00 | $2,912.00 |