| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $407.38 | $831.76 | $1,819.70 |
Aetna
| Professional | QZ | $407.38 | $616.60 | $1,148.15 |
Ambetter
| Professional | AA | $158.49 | $190.55 | $512.86 |
Ambetter
| Professional | QZ | $141.25 | $218.78 | $512.86 |