| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $392.00 | $392.00 | $454.51 |
Aetna
| Professional | QZ | $655.70 | $655.70 | $695.20 |
Ambetter
| Professional | AA | $170.71 | $170.71 | $195.10 |
Ambetter
| Professional | QZ | $136.57 | $214.61 | $590.00 |