| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,097.50 | $5,226.00 | $8,983.54 | |
Aetna
| Facility | 50 | $2,954.50 | $6,996.00 | $9,994.50 |
Kaiser Permanente
| Professional | $896.19 | $1,855.31 | $1,855.31 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |