| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $604.50 | $942.50 | $1,540.00 |
Aetna
| Professional | QZ | $215.39 | $565.54 | $1,275.00 |
Ambetter
| Professional | AA | $12.94 | $431.73 | $845.00 |
Ambetter
| Professional | QZ | $254.90 | $254.90 | $254.90 |