| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $412.00 | $412.00 | $412.00 | |
HMSA
| Facility | $351.79 | $394.00 | $638.00 | |
Kaiser Permanente
| Facility | $110.00 | $110.00 | $280.00 | |
University Health Alliance
| Facility | $110.00 | $110.00 | $110.00 |