| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $624.10 | $987.70 | $2,380.00 |
Ambetter
| Professional | AA | $525.84 | $961.02 | $2,669.50 |
Ambetter
| Professional | QZ | $1,174.58 | $1,174.58 | $1,174.58 |
United
| Professional | QY | $80.00 | $80.00 | $80.00 |