| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,260.00 | $1,260.00 | $1,260.00 |
Aetna
| Professional | QZ | $760.93 | $930.00 | $987.01 |
Ambetter
| Professional | AA | $349.02 | $368.41 | $1,040.00 |
Ambetter
| Professional | QZ | $193.90 | $297.14 | $440.28 |