| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $392.00 | $392.00 | $995.40 |
Aetna
| Professional | QZ | $840.00 | $840.00 | $884.80 |
Ambetter
| Professional | AA | $157.60 | $197.00 | $197.00 |
Ambetter
| Professional | QZ | $137.90 | $186.17 | $212.76 |