| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,750.00 | $2,750.00 | $2,750.00 | |
Ambetter
| Facility | $15.19 | $2,269.87 | $5,045.31 | |
HealthNet
| Facility | $1,240.76 | $7,915.05 | $30,229.99 | |
Kaiser Permanente
| Facility | $118.50 | $195.00 | $315.00 |