| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $786.50 | $1,254.00 | $1,625.60 |
Aetna
| Professional | QZ | $296.83 | $927.10 | $1,752.60 |
Ambetter
| Professional | AA | $227.62 | $840.00 | $1,495.00 |
Ambetter
| Professional | QZ | $200.90 | $1,170.00 | $1,690.00 |