| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $602.56 | $602.56 | $758.58 |
Aetna
| Professional | AA | $575.44 | $1,318.26 | $2,089.30 |
Aetna
| Professional | QZ | $524.81 | $660.69 | $933.25 |
Ambetter
| Professional | AA | $457.09 | $457.09 | $457.09 |
Ambetter
| Professional | QZ | $234.42 | $234.42 | $234.42 |