| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $478.63 | $2,511.89 | $4,073.80 | |
Aetna
| Facility | 50 | $1,737.80 | $1,737.80 | $1,737.80 |
Kaiser Permanente
| Professional | $954.99 | $1,000.00 | $2,137.96 | |
United
| Facility | $741.31 | $1,737.80 | $10,471.29 |