| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $724.44 | $794.33 | $954.99 |
Aetna
| Professional | QZ | $602.56 | $602.56 | $645.65 |
Ambetter
| Professional | AA | $120.23 | $173.78 | $562.34 |
Ambetter
| Professional | QZ | $158.49 | $199.53 | $537.03 |