| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $2,761.00 | $4,100.00 | |
Aetna
| Facility | 52 | $429.03 | $429.03 | $429.03 |
Kaiser Permanente
| Professional | $827.01 | $1,808.92 | $1,808.92 | |
United
| Facility | $12,497.00 | $15,950.00 | $53,591.00 |