| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $390.15 | $390.15 | $390.15 |
Aetna
| Facility | QX | $862.40 | $862.40 | $862.40 |
Aetna
| Professional | AA | $158.61 | $336.22 | $840.00 |
Ambetter
| Professional | AA | $98.90 | $178.02 | $197.80 |
BCBS
| Professional | AA | $105.00 | $175.50 | $255.54 |