| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $537.60 | $3,670.00 | $4,073.38 | |
Aetna
| Facility | 52 | $111.08 | $111.08 | $111.08 |
Kaiser Permanente
| Professional | $197.03 | $401.09 | $433.03 | |
United
| Facility | $808.00 | $1,171.00 | $26,408.00 |