| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $707.95 | $707.95 | $707.95 | |
Aetna
| Professional | $707.95 | $707.95 | $1,174.90 | |
Anthem BCBS
| Professional | $223.87 | $251.19 | $251.19 | |
Kaiser Permanente
| Professional | $1,659.59 | $1,659.59 | $1,659.59 |