| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $36.86 | $36.86 | $36.86 |
Aetna
| Professional | QZ | $218.48 | $218.48 | $218.48 |
Ambetter
| Professional | AA | $136.57 | $136.57 | $175.59 |
Ambetter
| Professional | QZ | $195.10 | $195.10 | $195.10 |