| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $616.60 | $616.60 | $851.14 |
Aetna
| Professional | AA | $549.54 | $1,737.80 | $2,511.89 |
Aetna
| Professional | QZ | $173.78 | $173.78 | $181.97 |
Ambetter
| Professional | AA | $316.23 | $776.25 | $977.24 |
Ambetter
| Professional | QZ | $275.42 | $295.12 | $338.84 |