| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $2,747.00 | $2,747.00 | |
Aetna
| Professional | $3.71 | $3.71 | $3.71 | |
Kaiser Permanente
| Professional | $200.00 | $200.00 | $200.00 | |
United
| Facility | $1,106.00 | $1,106.00 | $1,106.00 |