| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $604.49 | $3,999.00 | $6,456.00 | |
Aetna
| Facility | 50 | $4,975.00 | $4,975.00 | $4,975.00 |
Kaiser Permanente
| Professional | $239.32 | $524.54 | $524.54 | |
United
| Facility | $2,648.00 | $8,777.00 | $26,408.00 |