| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $326.58 | $326.58 | $1,990.80 |
Aetna
| Professional | QZ | $1,980.00 | $1,980.00 | $1,980.00 |
Ambetter
| Professional | AA | $275.80 | $275.80 | $315.20 |
Ambetter
| Professional | QZ | $275.80 | $318.16 | $472.80 |