| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $551.23 | $3,999.00 | $4,975.00 | |
Aetna
| Facility | 52 | $123.31 | $123.31 | $123.31 |
Kaiser Permanente
| Professional | $219.25 | $447.03 | $481.16 | |
United
| Facility | $2,648.00 | $3,378.00 | $26,408.00 |