| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $627.20 | $937.98 | $1,540.00 |
Aetna
| Professional | QZ | $620.25 | $620.25 | $1,372.30 |
Ambetter
| Professional | AA | $140.41 | $260.77 | $825.00 |
Ambetter
| Professional | QZ | $200.60 | $225.68 | $385.00 |