| 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 | $22.79 | $22.79 | $22.79 |
Aetna
| Facility | 53 | $9.11 | $9.11 | $9.11 |
Kaiser Permanente
| Professional | $40.15 | $80.84 | $87.61 | |
United
| Facility | $37.72 | $442.00 | $5,940.00 |