| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $4,673.00 | $7,007.00 | |
Aetna
| Facility | 50 | $6,663.00 | $9,519.00 | $9,994.50 |
Kaiser Permanente
| Professional | $453.50 | $996.10 | $996.10 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |