| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $391.50 | $603.00 | $873.00 |
Aetna
| Professional | QZ | $364.40 | $467.05 | $751.50 |
Ambetter
| Professional | AA | $180.99 | $388.98 | $828.00 |
Ambetter
| Professional | QZ | $140.41 | $257.62 | $900.00 |