| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $645.65 | $1,096.48 | $1,621.81 |
Aetna
| Professional | QZ | $758.58 | $794.33 | $1,445.44 |
Ambetter
| Professional | AA | $257.04 | $891.25 | $1,949.84 |
Ambetter
| Professional | QZ | $162.18 | $1,380.38 | $1,905.46 |