| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $977.24 | $4,786.30 | $6,918.31 | |
Aetna
| Facility | 50 | $5,495.41 | $5,495.41 | $5,495.41 |
Kaiser Permanente
| Professional | $354.81 | $371.54 | $851.14 | |
United
| Facility | $4,073.80 | $16,218.10 | $33,884.42 |