| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $251.07 | $4,004.00 | $4,467.00 | |
Aetna
| Facility | 52 | $1,816.34 | $1,816.34 | $2,233.50 |
Kaiser Permanente
| Professional | $109.51 | $217.34 | $237.91 | |
United
| Facility | $808.00 | $1,171.00 | $26,408.00 |