| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $758.58 | $1,318.26 | $2,344.23 |
Aetna
| Professional | QZ | $616.60 | $1,380.38 | $2,089.30 |
Ambetter
| Professional | AA | $776.25 | $1,819.70 | $2,454.71 |
Ambetter
| Professional | QZ | $269.15 | $1,288.25 | $3,019.95 |