| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $776.25 | $933.25 | $3,090.30 |
Aetna
| Professional | QZ | $954.99 | $954.99 | $954.99 |
Ambetter
| Professional | AA | $239.88 | $239.88 | $239.88 |
Ambetter
| Professional | QZ | $162.18 | $181.97 | $199.53 |