| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $363.08 | $645.65 | $851.14 |
Aetna
| Professional | QZ | $263.03 | $501.19 | $776.25 |
Ambetter
| Professional | AA | $104.71 | $134.90 | $199.53 |
Ambetter
| Professional | QZ | $100.00 | $144.54 | $186.21 |