| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $454.91 | $600.00 | $610.60 |
Aetna
| Professional | QX | $212.40 | $266.60 | $559.00 |
Aetna
| Professional | QZ | $412.26 | $412.26 | $469.00 |
Ambetter
| Professional | AA | $102.20 | $102.20 | $124.38 |