| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $5,545.00 | $7,007.00 | |
Aetna
| Facility | 50 | $9,994.50 | $9,994.50 | $9,994.50 |
Kaiser Permanente
| Professional | $2,964.53 | $6,149.63 | $6,149.63 | |
United
| Facility | $2,542.35 | $4,165.00 | $26,408.00 |