| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | QX | $575.98 | $575.98 | $575.98 |
Ambetter
| Professional | AA | $145.11 | $145.11 | $145.11 |
Ambetter
| Professional | QX | $51.83 | $51.83 | $752.00 |
Ambetter
| Professional | QZ | $124.38 | $145.11 | $910.00 |