| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $954.99 | $954.99 | $954.99 |
Aetna
| Professional | QZ | $229.09 | $870.96 | $870.96 |
Ambetter
| Professional | QZ | $141.25 | $162.18 | $218.78 |
Lucent Health
| Facility | QK | $52.48 | $52.48 | $52.48 |
Lucent Health
| Facility | QX | $52.48 | $52.48 | $52.48 |
Lucent Health
| Facility | QY | $52.48 | $52.48 | $52.48 |