| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $1,482.57 | $1,482.57 | $1,482.57 |
Aetna
| Facility | QX | $2,441.88 | $2,441.88 | $2,441.88 |
Ambetter
| Professional | QZ | $1,173.00 | $1,173.00 | $1,173.00 |
BCBS
| Professional | QZ | $420.00 | $600.00 | $907.50 |