| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $624.00 | $624.00 | $624.00 |
Aetna
| Professional | QZ | $954.20 | $954.20 | $954.20 |
Ambetter
| Professional | QZ | $628.88 | $628.88 | $1,179.15 |
Cigna
| Professional | AA | $411.42 | $411.42 | $514.28 |