| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $165.02 | $1,440.00 | $3,175.00 | |
Aetna
| Facility | 52 | $37.64 | $37.64 | $72.73 |
Kaiser Permanente
| Professional | $124.86 | $277.36 | $277.36 | |
United
| Facility | $165.00 | $549.00 | $5,940.00 |