| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $234.42 | $234.42 | $489.78 |
Aetna
| Professional | QZ | $218.78 | $218.78 | $524.81 |
Ambetter
| Professional | AA | $154.88 | $154.88 | $154.88 |
Ambetter
| Professional | QZ | $147.91 | $223.87 | $457.09 |
Qualchoice
| Professional | QZ | $467.74 | $467.74 | $524.81 |