| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $165.44 | $165.44 | $165.44 | |
Aetna
| Professional | $158.52 | $165.44 | $204.27 | |
Anthem BCBS
| Professional | $140.16 | $175.00 | $404.75 | |
Kaiser Permanente
| Professional | $252.48 | $252.48 | $290.35 |