| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $2,986.00 | $6,456.00 | |
Aetna
| Facility | 53 | $127.51 | $127.51 | $127.51 |
Kaiser Permanente
| Professional | $1,123.10 | $1,123.10 | $1,123.10 | |
United
| Facility | $12,497.00 | $15,950.00 | $49,818.00 |