| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $640.00 | $640.00 | $640.00 | |
Aetna
| Professional | $640.00 | $640.00 | $1,820.00 | |
Anthem BCBS
| Professional | $169.55 | $199.48 | $306.70 | |
Kaiser Permanente
| Professional | $1,437.00 | $1,516.00 | $1,516.00 |