| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QZ | $537.03 | $1,230.27 | $1,230.27 |
Aetna
| Professional | AA | $371.54 | $588.84 | $1,548.82 |
Ambetter
| Professional | AA | $128.82 | $194.98 | $891.25 |
Cigna
| Professional | AA | $281.84 | $281.84 | $354.81 |