| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $445.45 | $696.85 | $1,260.00 |
Aetna
| Professional | QZ | $210.00 | $432.02 | $601.44 |
Ambetter
| Professional | AA | $160.32 | $455.00 | $759.00 |
Ambetter
| Professional | QZ | $182.55 | $280.83 | $660.00 |