| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $531.29 | $3,854.00 | $4,337.00 | |
Aetna
| Facility | 52 | $114.02 | $114.02 | $114.02 |
Aetna
| Facility | 53 | $45.61 | $45.61 | $45.61 |
Kaiser Permanente
| Professional | $202.41 | $410.43 | $444.06 | |
United
| Facility | $808.00 | $1,171.00 | $26,408.00 |