| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $588.00 | $588.00 | $588.00 |
Aetna
| Professional | QZ | $330.15 | $334.80 | $458.20 |
Ambetter
| Professional | AA | $174.51 | $174.51 | $200.60 |
Ambetter
| Professional | QZ | $155.12 | $176.45 | $266.61 |