| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $489.78 | $1,819.70 | $1,819.70 |
Aetna
| Professional | QZ | $524.81 | $562.34 | $933.25 |
Ambetter
| Professional | AA | $489.78 | $489.78 | $489.78 |
Ambetter
| Professional | QZ | $218.78 | $223.87 | $457.09 |