| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $389.05 | $724.44 | $1,905.46 |
Aetna
| Professional | QX | $257.04 | $389.05 | $741.31 |
Aetna
| Professional | QY | $269.15 | $389.05 | $1,202.26 |
Aetna
| Professional | QZ | $100.00 | $549.54 | $602.56 |
Ambetter
| Professional | QZ | $120.23 | $120.23 | $323.59 |