| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $216.89 | $994.14 | $1,820.00 |
Aetna
| Professional | QZ | $1,313.18 | $1,313.18 | $1,313.18 |
Ambetter
| Professional | AA | $180.99 | $360.00 | $535.73 |
Ambetter
| Professional | QZ | $1,067.80 | $1,067.80 | $1,067.80 |