| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $3,854.00 | $4,100.00 | |
Aetna
| Facility | 50 | $1,708.50 | $2,789.45 | $5,125.50 |
Kaiser Permanente
| Professional | $493.32 | $1,026.25 | $1,026.25 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |