| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $840.00 | $888.00 | |
Aetna
| Professional | AA | $210.03 | $210.03 | $784.40 |
Aetna
| Professional | QK | $444.00 | $444.00 | $444.00 |
Kaiser Permanente
| Professional | $563.28 | $563.28 | $608.00 |