| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $4,100.00 | $6,945.00 | |
Aetna
| Facility | 54 | $657.06 | $657.06 | $657.06 |
Kaiser Permanente
| Professional | $713.75 | $826.45 | $1,574.85 | |
United
| Facility | $1,832.00 | $2,343.00 | $26,408.00 |