| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,200.00 | $1,200.00 | $1,200.00 | |
HMSA
| Facility | $962.00 | $962.00 | $962.00 | |
Kaiser Permanente
| Facility | $110.00 | $110.00 | $280.00 | |
United
| Facility | $1,389.00 | $1,389.00 | $1,389.00 |