| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $616.60 | $1,348.96 | $1,584.89 |
Aetna
| Professional | QZ | $302.00 | $302.00 | $302.00 |
Ambetter
| Professional | AA | $645.65 | $645.65 | $1,047.13 |
Ambetter
| Professional | QZ | $1,047.13 | $1,047.13 | $1,047.13 |