| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $588.84 | $851.14 | $1,023.29 |
Aetna
| Professional | QZ | $331.13 | $537.03 | $831.76 |
Ambetter
| Professional | AA | $141.25 | $165.96 | $181.97 |
Ambetter
| Professional | QZ | $134.90 | $181.97 | $245.47 |