| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,016.00 | $1,130.30 | $1,754.50 |
Aetna
| Professional | QZ | $810.70 | $839.50 | $1,181.09 |
Ambetter
| Professional | AA | $309.29 | $912.12 | $1,430.00 |
Ambetter
| Professional | QZ | $165.84 | $1,040.00 | $1,690.00 |