| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $602.56 | $602.56 | $602.56 |
Aetna
| Facility | QX | $977.24 | $977.24 | $977.24 |
Aetna
| Professional | AA | $331.13 | $676.08 | $1,202.26 |
Ambetter
| Professional | AA | $120.23 | $199.53 | $407.38 |
BCBS
| Professional | AA | $112.20 | $181.97 | $245.47 |