| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,324.03 | $2,747.00 | $4,456.00 | |
Aetna
| Facility | 50 | $4,456.00 | $4,456.00 | $4,456.00 |
Kaiser Permanente
| Professional | $405.69 | $442.57 | $516.33 | |
United
| Facility | $2,155.00 | $2,155.00 | $2,155.00 |