| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $423.40 | $423.40 | $504.00 |
Aetna
| Professional | QZ | $275.70 | $492.90 | $492.90 |
Ambetter
| Professional | AA | $135.72 | $242.38 | $510.00 |
Ambetter
| Professional | QZ | $116.34 | $142.52 | $339.33 |