| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $115.83 | $115.83 | $115.83 | |
Aetna
| Professional | $110.99 | $121.19 | $374.50 | |
Anthem BCBS
| Professional | $116.00 | $177.00 | $258.98 | |
Kaiser Permanente
| Professional | $151.18 | $151.18 | $181.42 |