| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $793.50 | $1,254.00 | $1,625.60 |
Aetna
| Professional | QZ | $1,104.90 | $1,104.90 | $1,369.90 |
Ambetter
| Professional | AA | $145.11 | $784.00 | $1,690.00 |
Ambetter
| Professional | QZ | $180.81 | $1,170.00 | $2,470.00 |