| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $234.42 | $234.42 | $234.42 |
Aetna
| Professional | QX | $269.15 | $380.19 | $537.03 |
Aetna
| Professional | QY | $269.15 | $269.15 | $389.05 |
Aetna
| Professional | QZ | $549.54 | $549.54 | $602.56 |
Ambetter
| Professional | QZ | $269.15 | $269.15 | $269.15 |
Cigna
| Professional | AA | $281.84 | $281.84 | $354.81 |