| 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 | $142.24 | $142.24 | $142.24 |
Aetna
| Facility | 53 | $56.89 | $56.89 | $56.89 |
Kaiser Permanente
| Professional | $251.93 | $517.10 | $553.91 | |
United
| Facility | $808.00 | $1,171.00 | $26,408.00 |