| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $776.25 | $1,513.56 | $2,511.89 |
Aetna
| Professional | QZ | $741.31 | $1,122.02 | $2,041.74 |
Ambetter
| Professional | AA | $316.23 | $524.81 | $1,380.38 |
Ambetter
| Professional | QZ | $218.78 | $295.12 | $309.03 |