| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $746.27 | $1,463.61 | $1,960.00 |
Aetna
| Professional | QZ | $3,106.75 | $3,106.75 | $3,106.75 |
Ambetter
| Professional | AA | $187.56 | $391.17 | $1,365.00 |
Ambetter
| Professional | QZ | $220.66 | $263.39 | $581.74 |