| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $254.94 | $254.94 | $254.94 | |
Aetna
| Professional | $17.60 | $254.94 | $254.94 | |
Anthem BCBS
| Professional | $21.25 | $25.00 | $31.12 | |
Kaiser Permanente
| Professional | $923.00 | $923.00 | $923.00 |