| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $4,100.00 | $6,150.00 | |
Aetna
| Facility | 50 | $4,225.50 | $5,194.00 | $7,392.00 |
Kaiser Permanente
| Professional | $791.26 | $1,634.25 | $1,634.25 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |