| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $604.52 | $604.52 | $760.28 |
Aetna
| Professional | AA | $397.70 | $1,400.00 | $2,100.00 |
Aetna
| Professional | QZ | $306.55 | $306.55 | $306.55 |
Ambetter
| Professional | AA | $231.86 | $231.86 | $897.00 |
Ambetter
| Professional | QZ | $135.59 | $213.07 | $213.07 |