| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $110.80 | $110.80 | $110.80 | |
Aetna
| Professional | $106.15 | $110.80 | $151.62 | |
Anthem BCBS
| Professional | $82.00 | $113.35 | $212.45 | |
Kaiser Permanente
| Professional | $173.66 | $173.66 | $199.71 |