| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $467.74 | $933.25 | $1,548.82 |
Aetna
| Professional | QZ | $346.74 | $676.08 | $1,122.02 |
Ambetter
| Professional | AA | $173.78 | $645.65 | $1,071.52 |
Ambetter
| Professional | QZ | $144.54 | $691.83 | $1,445.44 |