| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $124.52 | $725.40 | $725.40 |
Aetna
| Professional | QZ | $479.48 | $479.48 | $479.48 |
Ambetter
| Professional | AA | $291.74 | $560.00 | $960.00 |
Ambetter
| Professional | QZ | $140.41 | $216.94 | $750.00 |