| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $239.88 | $588.84 | $977.24 |
Aetna
| Professional | QZ | $91.20 | $407.38 | $489.78 |
Ambetter
| Professional | AA | $478.63 | $691.83 | $912.01 |
Ambetter
| Professional | QZ | $162.18 | $436.52 | $912.01 |