| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $562.34 | $870.96 | $1,621.81 |
Aetna
| Professional | QZ | $363.08 | $616.60 | $891.25 |
Ambetter
| Professional | AA | $151.36 | $218.78 | $691.83 |
Ambetter
| Professional | QZ | $154.88 | $181.97 | $602.56 |