| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $467.74 | $812.83 | $1,412.54 |
Aetna
| Professional | QZ | $645.65 | $891.25 | $1,230.27 |
Ambetter
| Professional | AA | $169.82 | $263.03 | $870.96 |
Ambetter
| Professional | QZ | $199.53 | $281.84 | $1,023.29 |
Cigna
| Professional | AA | $416.87 | $416.87 | $524.81 |