| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $7,727.00 | $9,719.00 | |
Aetna
| Facility | 22 | $9,719.00 | $9,719.00 | $9,719.00 |
Kaiser Permanente
| Professional | $1,360.85 | $2,989.02 | $2,989.02 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |