| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $630.69 | $1,400.00 | $1,960.00 |
Aetna
| Professional | QZ | $251.64 | $251.64 | $251.64 |
Ambetter
| Professional | AA | $825.00 | $825.00 | $825.00 |
Ambetter
| Professional | QZ | $193.90 | $193.90 | $193.90 |