| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $423.40 | $840.00 | $877.80 |
Aetna
| Professional | QZ | $260.39 | $288.30 | $551.40 |
Ambetter
| Professional | AA | $135.72 | $252.07 | $845.00 |
Ambetter
| Professional | QZ | $155.12 | $183.24 | $401.37 |