| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $774.20 | $774.20 | $840.00 |
Aetna
| Professional | QZ | $774.20 | $810.00 | $995.40 |
Ambetter
| Professional | AA | $157.60 | $157.60 | $157.60 |
Ambetter
| Professional | QZ | $160.40 | $177.30 | $496.00 |