| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QZ | $776.25 | $776.25 | $776.25 |
Aetna
| Professional | AA | $676.08 | $1,023.29 | $1,778.28 |
Aetna
| Professional | QZ | $812.83 | $1,288.25 | $2,187.76 |
Ambetter
| Professional | AA | $309.03 | $309.03 | $309.03 |
Ambetter
| Professional | QZ | $199.53 | $199.53 | $199.53 |