| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $315.93 | $1,540.00 | $2,520.00 |
Aetna
| Professional | QZ | $321.22 | $321.22 | $321.22 |
Ambetter
| Professional | AA | $253.98 | $253.98 | $960.00 |
Ambetter
| Professional | QZ | $329.63 | $1,414.98 | $1,414.98 |
Cigna
| Professional | AA | $479.99 | $479.99 | $599.99 |