| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.00 | $400.00 | $450.00 | |
Ambetter
| Professional | AA | $111.38 | $111.38 | $111.38 |
Ambetter
| Professional | QZ | $133.65 | $133.65 | $133.65 |
CareSource
| Facility | $51.62 | $130.75 | $201.45 |