| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $587.64 | $3,670.00 | $4,100.00 | |
Aetna
| Facility | 52 | $131.44 | $131.44 | $131.44 |
Kaiser Permanente
| Professional | $234.38 | $476.34 | $512.89 | |
United
| Facility | $808.00 | $1,171.00 | $26,408.00 |