| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $384.00 | $572.55 | $663.57 |
Ambetter
| Professional | AA | $140.63 | $498.83 | $1,060.85 |
Kaiser Permanente
| Professional | QK | $98.31 | $98.31 | $131.60 |
Kaiser Permanente
| Professional | QX | $98.31 | $98.31 | $131.60 |
Kaiser Permanente
| Professional | QY | $98.31 | $98.31 | $131.60 |