| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $57.12 | $57.12 | $324.95 |
Aetna
| Professional | AA | $537.20 | $639.90 | $1,400.00 |
Ambetter
| Professional | AA | $135.59 | $259.32 | $320.64 |
United
| Professional | AA | $85.00 | $85.00 | $85.00 |