| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $758.58 | $1,258.93 | $1,862.09 |
Aetna
| Professional | QZ | $354.81 | $1,047.13 | $1,380.38 |
Ambetter
| Professional | AA | $194.98 | $194.98 | $194.98 |
Ambetter
| Professional | QZ | $245.47 | $245.47 | $245.47 |