| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $551.62 | $551.62 | $722.50 |
Aetna
| Facility | QX | $454.27 | $454.27 | $595.00 |
Ambetter
| Professional | QZ | $212.64 | $212.64 | $276.43 |
BCBS
| Professional | QZ | $112.00 | $160.00 | $242.00 |