| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $33.81 | $33.81 | $360.50 | |
Ambetter
| Professional | AA | $100.25 | $100.25 | $147.63 |
Ambetter
| Professional | QY | $50.13 | $50.13 | $50.13 |
Emblem Health
| Facility | $375.00 | $375.00 | $375.00 |