| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $289.45 | $720.00 | $864.00 |
Aetna
| Professional | QZ | $249.01 | $385.02 | $790.50 |
Ambetter
| Professional | AA | $135.72 | $252.07 | $520.00 |
Ambetter
| Professional | QZ | $155.12 | $200.69 | $540.00 |