| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $4,047.00 | $4,601.00 | |
Aetna
| Facility | 52 | $182.08 | $182.08 | $182.08 |
Aetna
| Facility | 53 | $72.83 | $72.83 | $72.83 |
Kaiser Permanente
| Professional | $323.57 | $660.25 | $711.65 | |
United
| Facility | $1,832.00 | $2,343.00 | $26,408.00 |