| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $925.07 | $925.07 | $925.07 |
Aetna
| Professional | QZ | $402.00 | $520.00 | $604.50 |
Ambetter
| Professional | QZ | $200.76 | $393.05 | $675.00 |
Cigna
| Professional | AA | $342.85 | $342.85 | $428.56 |