| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.00 | $275.00 | $350.00 | |
Aetna
| Professional | AA | $514.40 | $514.40 | $514.40 |
Aetna
| Professional | QZ | $116.11 | $217.43 | $775.68 |
Denver HMP
| Facility | $55.50 | $2,775.00 | $4,810.00 | |
Kaiser Permanente
| Professional | $260.00 | $375.00 | $621.60 |