| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $4,004.00 | $4,601.00 | |
Aetna
| Facility | 54 | $590.53 | $590.53 | $590.53 |
Kaiser Permanente
| Professional | $828.42 | $1,726.43 | $1,726.43 | |
United
| Facility | $665.00 | $762.00 | $6,342.00 |