| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $707.95 | $933.25 | $1,122.02 | |
Ambetter
| Professional | $1,412.54 | $1,412.54 | $1,412.54 | |
Qualchoice
| Professional | $1,621.81 | $1,621.81 | $1,621.81 | |
United
| Professional | $812.83 | $1,047.13 | $1,737.80 |