| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,964.02 | $1,964.02 | $2,312.00 |
Aetna
| Professional | QZ | $1,124.20 | $1,124.20 | $1,124.20 |
Ambetter
| Professional | AA | $356.22 | $1,300.00 | $1,300.00 |
United
| Professional | QZ | $80.00 | $80.00 | $80.00 |