| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $426.37 | $426.37 | $683.22 |
Aetna
| Professional | AA | $744.12 | $744.12 | $744.12 |
Ambetter
| Professional | AA | $176.27 | $235.98 | $277.06 |
Ambetter
| Professional | QZ | $254.90 | $254.90 | $254.90 |