| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $368.54 | $1,793.00 | $4,100.00 | |
Aetna
| Facility | 54 | $276.41 | $276.41 | $307.23 |
Kaiser Permanente
| Professional | $818.39 | $908.72 | $908.72 | |
United
| Facility | $165.00 | $442.00 | $5,940.00 |