| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $525.00 | $555.00 | |
Aetna
| Professional | AA | $436.60 | $495.80 | $614.20 |
Aetna
| Professional | QK | $222.00 | $277.50 | $332.00 |
Aetna
| Professional | QX | $56.55 | $56.55 | $56.55 |
Aetna
| Professional | QY | $210.90 | $233.10 | $270.10 |
Kaiser Permanente
| Professional | $352.05 | $352.05 | $380.00 |