| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $816.00 | $1,288.26 | $3,780.00 |
Aetna
| Professional | QZ | $1,536.24 | $1,536.24 | $1,536.24 |
Ambetter
| Professional | QZ | $316.95 | $316.95 | $426.58 |
Cigna
| Professional | AA | $754.27 | $754.27 | $942.84 |