| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $398.11 | $1,000.00 | $1,659.59 |
Aetna
| Professional | QZ | $147.91 | $891.25 | $1,096.48 |
Ambetter
| Professional | AA | $117.49 | $199.53 | $363.08 |
Ambetter
| Professional | QZ | $117.49 | $199.53 | $389.05 |