| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $369.68 | $369.68 | $369.68 | |
Aetna
| Professional | $369.68 | $369.68 | $442.97 | |
Anthem BCBS
| Professional | $359.10 | $378.00 | $378.00 | |
Kaiser Permanente
| Professional | $15,488.00 | $15,488.00 | $15,488.00 |