| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $5,383.00 | $6,996.00 | |
Aetna
| Facility | 50 | $3,568.50 | $9,519.00 | $9,519.00 |
Kaiser Permanente
| Professional | $1,026.52 | $2,130.29 | $2,130.29 | |
United
| Facility | $4,062.00 | $5,185.00 | $19,046.00 |