| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $645.65 | $645.65 | $645.65 | |
Aetna
| Professional | $645.65 | $645.65 | $1,819.70 | |
Anthem BCBS
| Professional | $199.53 | $199.53 | $416.87 | |
Kaiser Permanente
| Professional | $891.25 | $891.25 | $891.25 | |
Medcost
| Facility | $645.65 | $707.95 | $1,819.70 |