| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $436.52 | $912.01 | $1,698.24 |
Aetna
| Professional | QZ | $562.34 | $602.56 | $831.76 |
Ambetter
| Professional | AA | $213.80 | $213.80 | $645.65 |
Ambetter
| Professional | QZ | $199.53 | $239.88 | $263.03 |