| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $407.38 | $954.99 | $1,513.56 |
Aetna
| Professional | QZ | $281.84 | $891.25 | $1,318.26 |
Ambetter
| Professional | AA | $154.88 | $162.18 | $177.83 |
Ambetter
| Professional | QZ | $134.90 | $177.83 | $213.80 |