| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $3,360.00 | $3,360.00 | $3,780.00 |
Ambetter
| Professional | AA | $1,411.00 | $1,411.00 | $1,753.70 |
Ambetter
| Professional | QZ | $316.95 | $316.95 | $426.58 |
United
| Professional | QZ | $80.00 | $80.00 | $80.00 |