| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $149.15 | $765.00 | $946.16 |
Aetna
| Professional | QZ | $215.39 | $215.39 | $215.39 |
Ambetter
| Professional | AA | $178.11 | $475.42 | $900.00 |
Ambetter
| Professional | QZ | $240.72 | $458.10 | $600.00 |