| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,038.92 | $2,420.67 | $6,996.00 | |
Aetna
| Facility | 50 | $8,863.50 | $8,863.50 | $8,863.50 |
Kaiser Permanente
| Professional | $871.69 | $1,342.72 | $1,845.20 | |
United
| Facility | $1,832.00 | $6,073.00 | $26,408.00 |