| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $345.00 | $345.00 | $345.00 |
Aetna
| Professional | QZ | $246.45 | $265.05 | $279.00 |
Ambetter
| Professional | AA | $111.49 | $155.12 | $390.00 |
Ambetter
| Professional | QZ | $116.34 | $135.72 | $357.00 |