| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $478.63 | $851.14 | $1,174.90 |
Aetna
| Professional | QZ | $100.00 | $407.38 | $489.78 |
Ambetter
| Professional | AA | $125.89 | $125.89 | $138.04 |
Ambetter
| Professional | QZ | $120.23 | $138.04 | $162.18 |