| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $650.25 | $650.25 | $650.25 |
Aetna
| Facility | QX | $535.50 | $535.50 | $672.00 |
Aetna
| Professional | AA | $392.00 | $880.60 | $1,260.00 |
Ambetter
| Professional | AA | $138.46 | $178.02 | $191.37 |
BCBS
| Professional | AA | $105.00 | $175.50 | $255.54 |