| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $575.44 | $575.44 | $616.60 |
Aetna
| Professional | QZ | $295.12 | $302.00 | $575.44 |
Ambetter
| Professional | QZ | $309.03 | $309.03 | $436.52 |
Qualchoice
| Professional | QZ | $354.81 | $354.81 | $501.19 |