| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $700.00 | $1,540.00 | $2,380.00 |
Aetna
| Professional | QZ | $196.56 | $590.40 | $1,575.00 |
Ambetter
| Professional | AA | $414.00 | $414.00 | $414.00 |
Ambetter
| Professional | QZ | $176.00 | $176.00 | $703.12 |