| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $316.23 | $691.83 | $977.24 |
Aetna
| Professional | QZ | $100.00 | $407.38 | $562.34 |
Ambetter
| Professional | AA | $162.18 | $162.18 | $162.18 |
Ambetter
| Professional | QZ | $144.54 | $162.18 | $190.55 |
Aultcare
| Professional | AA | $281.84 | $281.84 | $309.03 |
Aultcare
| Professional | QZ | $229.09 | $363.08 | $501.19 |