| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $868.60 | $868.60 | $1,085.50 |
Aetna
| Professional | QZ | $689.48 | $1,402.50 | $1,402.50 |
Ambetter
| Professional | AA | $186.57 | $471.96 | $612.00 |
Ambetter
| Professional | QZ | $263.25 | $263.25 | $417.11 |