| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $848.82 | $848.82 | $848.82 |
Aetna
| Professional | AA | $538.97 | $667.00 | $873.20 |
Ambetter
| Professional | AA | $357.00 | $740.00 | $1,850.00 |
Wellcare
| Facility | QK | $37.00 | $37.00 | $39.50 |
Wellcare
| Facility | QX | $37.00 | $37.00 | $39.50 |
Wellcare
| Facility | QY | $37.00 | $37.00 | $39.50 |