| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $389.05 | $389.05 | $389.05 |
Aetna
| Facility | QX | $870.96 | $870.96 | $870.96 |
Aetna
| Professional | AA | $186.21 | $426.58 | $912.01 |
Ambetter
| Professional | AA | $181.97 | $223.87 | $457.09 |
BCBS
| Professional | AA | $112.20 | $181.97 | $245.47 |