| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $436.52 | $954.99 | $1,288.25 |
Aetna
| Professional | QZ | $288.40 | $870.96 | $1,023.29 |
Ambetter
| Professional | AA | $104.71 | $162.18 | $316.23 |
Ambetter
| Professional | QZ | $77.62 | $117.49 | $524.81 |