| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $2,986.00 | $6,456.00 | |
Aetna
| Facility | 50 | $2,826.75 | $6,768.00 | $9,684.00 |
Kaiser Permanente
| Professional | $472.47 | $547.07 | $1,037.96 | |
United
| Facility | $1,832.00 | $2,343.00 | $26,408.00 |