| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $4,673.00 | $6,996.00 | |
Aetna
| Facility | 50 | $2,379.00 | $8,040.00 | $9,994.50 |
Kaiser Permanente
| Professional | $1,292.58 | $2,675.58 | $2,675.58 | |
United
| Facility | $4,062.00 | $5,185.00 | $19,046.00 |