| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.65 | $136.65 | $136.65 | |
Aetna
| Professional | $79.59 | $136.65 | $201.68 | |
Anthem BCBS
| Professional | $82.56 | $122.00 | $280.00 | |
Kaiser Permanente
| Professional | $249.60 | $249.60 | $287.04 |