| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $4,100.00 | $7,007.00 | |
Aetna
| Facility | 52 | $896.43 | $896.43 | $896.43 |
Kaiser Permanente
| Professional | $1,900.14 | $3,946.45 | $3,946.45 | |
United
| Facility | $4,062.00 | $5,185.00 | $19,046.00 |