| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,467.37 | $3,467.37 | $3,467.37 | |
Aetna
| Professional | $1,380.38 | $3,467.37 | $7,244.36 | |
Kaiser Permanente
| Professional | $5,248.07 | $5,248.07 | $5,248.07 | |
United
| Professional | $1,230.27 | $5,888.44 | $8,912.51 |