| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,570.40 | $6,025.60 | $6,025.60 | |
Aetna
| Facility | 50 | $5,888.44 | $5,888.44 | $5,888.44 |
Kaiser Permanente
| Professional | $1,122.02 | $1,258.93 | $1,584.89 | |
United
| Facility | $3,311.31 | $3,311.31 | $3,311.31 |