| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $513.69 | $2,256.00 | $4,975.00 | |
Aetna
| Facility | 50 | $2,100.50 | $2,369.00 | $6,875.06 |
Kaiser Permanente
| Professional | $185.64 | $404.00 | $404.00 | |
United
| Facility | $1,832.00 | $2,343.00 | $26,408.00 |