| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $167.25 | $167.25 | $167.25 |
Aetna
| Professional | QZ | $360.80 | $488.25 | $488.25 |
Ambetter
| Professional | AA | $306.00 | $306.00 | $306.00 |
Ambetter
| Professional | QZ | $213.29 | $407.19 | $663.00 |