| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,412.54 | $4,786.30 | $6,918.31 | |
Aetna
| Facility | 50 | $9,772.37 | $9,772.37 | $9,772.37 |
Kaiser Permanente
| Professional | $416.87 | $478.63 | $1,348.96 | |
United
| Facility | $2,344.23 | $10,000.00 | $26,302.68 |