| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,213.08 | $3,818.00 | $6,996.00 | |
Aetna
| Facility | 50 | $2,954.50 | $2,954.50 | $9,994.50 |
Kaiser Permanente
| Professional | $480.02 | $1,052.13 | $1,052.13 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |