| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,137.96 | $5,495.41 | $7,762.47 | |
Aetna
| Facility | 50 | $10,000.00 | $10,000.00 | $10,000.00 |
Kaiser Permanente
| Professional | $2,454.71 | $5,623.41 | $6,165.95 | |
United
| Facility | $2,570.40 | $10,232.93 | $33,884.42 |