| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $489.78 | $630.96 | $851.14 |
Aetna
| Professional | QZ | $134.90 | $489.78 | $977.24 |
Ambetter
| Professional | AA | $158.49 | $177.83 | $645.65 |
Ambetter
| Professional | QZ | $134.90 | $199.53 | $467.74 |