| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $826.40 | $826.40 | $826.40 |
Aetna
| Professional | QZ | $408.80 | $442.40 | $700.40 |
Ambetter
| Professional | AA | $156.08 | $195.10 | $969.00 |
Ambetter
| Professional | QZ | $195.10 | $195.10 | $226.51 |