| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $326.04 | $403.07 | $980.00 |
Aetna
| Professional | QZ | $660.00 | $660.00 | $660.00 |
Ambetter
| Professional | AA | $98.95 | $98.95 | $180.33 |
Ambetter
| Professional | QZ | $351.05 | $552.00 | $736.00 |