| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $287.67 | $409.36 | $817.40 |
Aetna
| Professional | AA | $543.15 | $793.10 | $1,400.00 |
Aetna
| Professional | QZ | $398.85 | $553.63 | $1,292.15 |
Ambetter
| Professional | AA | $145.11 | $288.42 | $576.00 |
Ambetter
| Professional | QZ | $118.86 | $254.90 | $347.59 |