| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $987.23 | $987.23 | $987.23 |
Aetna
| Professional | AA | $622.88 | $895.95 | $1,540.00 |
Aetna
| Professional | QZ | $597.96 | $838.63 | $1,109.70 |
Ambetter
| Professional | AA | $240.48 | $360.18 | $780.00 |
Ambetter
| Professional | QZ | $140.41 | $180.54 | $441.32 |