| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,549.26 | $3,818.00 | $6,996.00 | |
Aetna
| Facility | 50 | $3,818.00 | $7,965.11 | $9,994.50 |
Kaiser Permanente
| Professional | $671.27 | $1,478.08 | $1,478.08 | |
United
| Facility | $4,062.00 | $5,185.00 | $19,046.00 |