| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $248.00 | $252.00 | $663.60 |
Aetna
| Professional | QZ | $588.00 | $588.00 | $663.60 |
Ambetter
| Professional | AA | $118.20 | $118.20 | $120.30 |
Ambetter
| Professional | QZ | $137.90 | $177.30 | $434.00 |