| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $600.00 | $600.00 | $600.00 | |
Aetna
| Professional | AA | $497.51 | $659.49 | $757.50 |
HMSA
| Professional | QZ | $3.72 | $4.18 | $4.38 |
Kaiser Permanente
| Professional | $178.11 | $280.00 | $524.79 |