| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $288.00 | $308.00 | $840.00 |
Aetna
| Professional | QZ | $672.00 | $672.00 | $672.00 |
Ambetter
| Professional | AA | $137.90 | $177.30 | $177.30 |
Ambetter
| Professional | QZ | $137.90 | $186.17 | $620.00 |