| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $257.04 | $741.31 | $1,412.54 |
Aetna
| Professional | QZ | $812.83 | $812.83 | $812.83 |
Ambetter
| Professional | AA | $169.82 | $169.82 | $1,000.00 |
Ambetter
| Professional | QZ | $141.25 | $162.18 | $234.42 |