| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $436.52 | $707.95 | $1,548.82 |
Aetna
| Professional | QZ | $1,288.25 | $1,288.25 | $1,288.25 |
Ambetter
| Professional | AA | $120.23 | $229.09 | $354.81 |
Ambetter
| Professional | QZ | $162.18 | $181.97 | $288.40 |