| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $107.15 | $467.74 | $1,096.48 |
Aetna
| Professional | QZ | $446.68 | $446.68 | $446.68 |
Ambetter
| Professional | AA | $398.11 | $398.11 | $398.11 |
Ambetter
| Professional | QZ | $954.99 | $954.99 | $954.99 |