| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $375.00 | $375.00 | $375.00 | |
Aetna
| Professional | AA | $97.15 | $347.10 | $392.00 |
Aetna
| Professional | QK | $147.52 | $150.41 | $173.55 |
HMSA
| Professional | QZ | $3.72 | $4.18 | $4.38 |
Kaiser Permanente
| Professional | $111.32 | $175.00 | $328.00 |