| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $5,909.00 | $6,996.00 | |
Aetna
| Facility | 50 | $5,909.00 | $5,909.00 | $5,909.00 |
Kaiser Permanente
| Professional | $1,142.88 | $2,501.94 | $2,501.94 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |