| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $398.11 | $1,230.27 | $1,949.84 |
Aetna
| Professional | QZ | $251.19 | $1,698.24 | $1,698.24 |
Ambetter
| Professional | AA | $478.63 | $478.63 | $478.63 |
Ambetter
| Professional | QZ | $173.78 | $173.78 | $173.78 |