| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $575.44 | $1,445.44 | $2,238.72 |
Aetna
| Professional | QZ | $316.23 | $1,122.02 | $1,737.80 |
Ambetter
| Professional | AA | $102.33 | $204.17 | $288.40 |
Ambetter
| Professional | QZ | $120.23 | $239.88 | $302.00 |