| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $326.04 | $477.00 | $830.88 |
Aetna
| Professional | QZ | $98.82 | $345.49 | $660.00 |
Ambetter
| Professional | AA | $138.53 | $226.91 | $560.00 |
Ambetter
| Professional | QZ | $116.22 | $162.71 | $640.00 |