| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $456.50 | $1,209.22 | $1,680.00 |
Aetna
| Professional | QZ | $993.60 | $993.60 | $993.60 |
Ambetter
| Professional | AA | $197.90 | $197.90 | $197.90 |
Ambetter
| Professional | QZ | $242.00 | $680.00 | $816.34 |