| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $397.70 | $1,260.00 | $1,680.00 |
Aetna
| Professional | QZ | $674.41 | $674.41 | $674.41 |
Ambetter
| Professional | AA | $197.90 | $324.47 | $1,440.00 |
Ambetter
| Professional | QZ | $278.07 | $486.62 | $695.18 |