| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,818.38 | $2,818.38 | $2,818.38 | |
Aetna
| Professional | $169.82 | $338.84 | $794.33 | |
Kaiser Permanente
| Professional | $218.78 | $234.42 | $295.12 | |
United
| Facility | $2,454.71 | $2,454.71 | $2,454.71 | |
United
| Professional | $173.78 | $331.13 | $660.69 | |
University Health Alliance
| Professional | $29.51 | $218.78 | $234.42 |