| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $756.00 | $756.00 | $756.00 |
Aetna
| Professional | QZ | $272.72 | $330.15 | $339.45 |
Ambetter
| Professional | AA | $174.51 | $252.07 | $459.00 |
Ambetter
| Professional | QZ | $135.72 | $174.51 | $612.00 |