| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $261.80 | $261.80 | $261.80 | |
Aetna
| Professional | $261.80 | $261.80 | $3,300.77 | |
Anthem BCBS
| Professional | $23.75 | $25.00 | $25.00 | |
Kaiser Permanente
| Professional | $5,808.00 | $5,808.00 | $5,808.00 |