| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QZ | $489.78 | $489.78 | $489.78 |
Aetna
| Professional | AA | $346.74 | $831.76 | $1,412.54 |
Aetna
| Professional | QZ | $489.78 | $537.03 | $794.33 |
Ambetter
| Professional | AA | $177.83 | $177.83 | $177.83 |