| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $500.57 | $515.58 | $696.03 |
Ambetter
| Professional | AA | $510.00 | $510.00 | $510.00 |
Medica
| Facility | QK | $39.50 | $39.50 | $39.50 |
Medica
| Facility | QX | $39.50 | $39.50 | $39.50 |
Medica
| Facility | QY | $39.50 | $39.50 | $39.50 |