| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $2,290.87 | $2,290.87 | $2,290.87 |
Aetna
| Professional | QZ | $870.96 | $1,122.02 | $1,122.02 |
Ambetter
| Professional | QZ | $977.24 | $1,023.29 | $1,621.81 |
Qualchoice
| Professional | QZ | $1,122.02 | $1,202.26 | $1,862.09 |