| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $219.56 | $219.56 | $219.56 | |
Anthem BCBS
| Facility | $4,500.00 | $14,196.85 | $27,168.86 | |
Anthem BCBS
| Professional | $168.18 | $168.58 | $168.58 | |
Kaiser Permanente
| Professional | $1,194.00 | $1,209.00 | $16,272.00 |