| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $741.31 | $1,023.29 | $1,949.84 |
Aetna
| Professional | QZ | $851.14 | $1,202.26 | $1,202.26 |
Ambetter
| Professional | AA | $138.04 | $316.23 | $1,230.27 |
Ambetter
| Professional | QZ | $213.80 | $281.84 | $1,202.26 |