| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $483.80 | $483.80 | $598.85 |
Aetna
| Professional | QY | $281.45 | $281.45 | $281.45 |
Ambetter
| Professional | QZ | $325.00 | $325.00 | $325.00 |
Wellcare
| Facility | QK | $37.00 | $37.00 | $39.50 |
Wellcare
| Facility | QX | $37.00 | $37.00 | $39.50 |
Wellcare
| Facility | QY | $37.00 | $37.00 | $39.50 |