| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $4,633.00 | $6,150.00 | |
Aetna
| Facility | 50 | $2,817.00 | $7,614.00 | $7,791.00 |
Kaiser Permanente
| Professional | $747.13 | $1,546.72 | $1,546.72 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |