| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $811.98 | $1,120.00 | $1,400.00 |
Aetna
| Professional | QZ | $608.10 | $608.10 | $608.10 |
Ambetter
| Professional | AA | $160.47 | $168.50 | $660.00 |
Ambetter
| Professional | QZ | $140.41 | $440.00 | $440.00 |