| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $323.59 | $354.81 | $380.19 |
Aetna
| Professional | QX | $269.15 | $389.05 | $537.03 |
Aetna
| Professional | QY | $269.15 | $269.15 | $389.05 |
Ambetter
| Professional | AA | $79.43 | $79.43 | $79.43 |
Ambetter
| Professional | QZ | $120.23 | $120.23 | $120.23 |