| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $368.62 | $368.62 | $368.62 | |
Aetna
| Professional | $317.06 | $368.62 | $500.98 | |
Anthem BCBS
| Professional | $404.39 | $676.41 | $885.23 | |
Kaiser Permanente
| Professional | $385.47 | $385.47 | $763.71 |