| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $149.15 | $946.16 | $1,540.00 |
Aetna
| Professional | QZ | $215.39 | $215.39 | $258.83 |
Ambetter
| Professional | AA | $178.11 | $178.11 | $475.42 |
Ambetter
| Professional | QZ | $237.48 | $1,012.00 | $1,012.00 |