| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $41.10 | $52.36 | $71.40 |
Aetna
| Professional | AA | $330.00 | $352.50 | $980.00 |
Aetna
| Professional | QZ | $245.00 | $245.00 | $245.00 |
Ambetter
| Professional | AA | $98.95 | $180.33 | $305.89 |
Ambetter
| Professional | QZ | $99.05 | $162.21 | $212.63 |