| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $213.80 | $1,548.82 | $3,235.94 |
Aetna
| Professional | QZ | $758.58 | $1,479.11 | $1,479.11 |
Ambetter
| Professional | AA | $213.80 | $213.80 | $213.80 |
Ambetter
| Professional | QZ | $194.98 | $234.42 | $263.03 |