| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $598.23 | $598.23 | $598.23 |
Aetna
| Facility | QX | $985.32 | $985.32 | $985.32 |
Aetna
| Professional | AA | $327.71 | $840.00 | $1,260.00 |
Ambetter
| Professional | AA | $138.46 | $138.46 | $178.02 |
BCBS
| Professional | AA | $105.00 | $175.50 | $255.54 |