| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $989.90 | $5,578.00 | $7,879.55 | |
Aetna
| Facility | 50 | $5,504.47 | $5,504.47 | $5,504.47 |
Kaiser Permanente
| Professional | $393.13 | $860.75 | $860.75 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |