| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $632.91 | $720.80 | $720.80 |
Aetna
| Professional | QZ | $523.79 | $523.79 | $523.79 |
Ambetter
| Professional | AA | $271.18 | $503.62 | $1,120.00 |
Ambetter
| Professional | QZ | $154.96 | $154.96 | $1,040.00 |