| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,097.50 | $4,673.00 | $7,007.00 | |
Aetna
| Facility | 50 | $5,909.00 | $5,909.00 | $10,494.00 |
Kaiser Permanente
| Professional | $508.21 | $1,115.81 | $1,115.81 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |