| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,698.24 | $7,244.36 | $9,772.37 | |
Aetna
| Facility | 22 | $9,772.37 | $9,772.37 | $9,772.37 |
Kaiser Permanente
| Professional | $1,230.27 | $1,288.25 | $3,019.95 | |
United
| Facility | $4,073.80 | $16,218.10 | $33,884.42 |