| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $2,527.00 | $2,726.50 | $5,575.30 |
Aetna
| Professional | QZ | $3,915.00 | $3,915.00 | $3,915.00 |
Ambetter
| Professional | AA | $352.41 | $2,016.00 | $3,770.00 |
Ambetter
| Professional | QZ | $578.54 | $1,770.30 | $2,950.50 |