| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $436.52 | $1,000.00 | $1,737.80 |
Aetna
| Professional | QZ | $831.76 | $831.76 | $1,479.11 |
Ambetter
| Professional | AA | $354.81 | $354.81 | $354.81 |
Ambetter
| Professional | QZ | $199.53 | $263.03 | $302.00 |