| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $895.26 | $1,020.18 | $1,680.00 |
Aetna
| Professional | QZ | $939.25 | $939.25 | $1,156.00 |
Ambetter
| Professional | AA | $197.90 | $197.90 | $197.90 |
Ambetter
| Professional | QZ | $220.66 | $300.89 | $300.89 |