| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $33.11 | $363.08 | $363.08 | |
Aetna
| Professional | AA | $1,288.25 | $1,380.38 | $1,659.59 |
Aetna
| Professional | QX | $524.81 | $691.83 | $912.01 |
Ambetter
| Professional | QZ | $147.91 | $147.91 | $147.91 |
Emblem Health
| Facility | $371.54 | $371.54 | $371.54 |