| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $428.33 | $693.00 | $909.00 |
Aetna
| Professional | QZ | $289.33 | $518.24 | $720.50 |
Ambetter
| Professional | AA | $180.99 | $395.80 | $871.00 |
Ambetter
| Professional | QZ | $158.32 | $271.18 | $707.97 |