| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,348.96 | $4,073.80 | $7,079.46 | |
Aetna
| Facility | 22 | $2,754.23 | $2,754.23 | $2,754.23 |
Kaiser Permanente
| Professional | $1,122.02 | $1,174.90 | $2,884.03 | |
United
| Facility | $9,120.11 | $25,703.96 | $52,480.75 |