| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $588.84 | $588.84 | $588.84 |
Aetna
| Professional | AA | $630.96 | $1,174.90 | $2,570.40 |
Aetna
| Professional | QZ | $676.08 | $954.99 | $1,148.15 |
Ambetter
| Professional | AA | $346.74 | $346.74 | $346.74 |
Ambetter
| Professional | QZ | $173.78 | $199.53 | $524.81 |