| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $602.56 | $1,122.02 | $2,238.72 |
Aetna
| Professional | QZ | $194.98 | $758.58 | $1,584.89 |
Ambetter
| Professional | AA | $158.49 | $158.49 | $158.49 |
Ambetter
| Professional | QZ | $218.78 | $218.78 | $218.78 |