| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $774.20 | $774.20 | $774.20 |
Aetna
| Professional | QZ | $884.80 | $884.80 | $884.80 |
Ambetter
| Professional | AA | $160.40 | $197.00 | $236.40 |
Ambetter
| Professional | QZ | $216.70 | $220.55 | $239.36 |