| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $616.44 | $616.44 | $847.28 |
Aetna
| Professional | AA | $225.43 | $1,350.20 | $1,358.80 |
Ambetter
| Professional | AA | $168.25 | $374.17 | $742.90 |
Ambetter
| Professional | QZ | $301.24 | $301.24 | $301.24 |