| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $690.98 | $690.98 | $690.98 |
Aetna
| Professional | QZ | $946.16 | $946.16 | $946.16 |
Ambetter
| Professional | AA | $395.80 | $395.80 | $395.80 |
Ambetter
| Professional | QZ | $178.11 | $178.11 | $420.54 |