| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $812.83 | $2,454.71 | $3,162.28 |
Aetna
| Professional | QZ | $3,311.31 | $3,311.31 | $3,311.31 |
Ambetter
| Professional | AA | $323.59 | $323.59 | $323.59 |
Ambetter
| Professional | QZ | $363.08 | $363.08 | $363.08 |