| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,949.84 | $1,949.84 | $1,949.84 |
Aetna
| Professional | QZ | $676.08 | $1,122.02 | $1,122.02 |
Ambetter
| Professional | AA | $426.58 | $426.58 | $426.58 |
Ambetter
| Professional | QZ | $354.81 | $446.68 | $1,698.24 |