| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,820.00 | $2,520.00 | $3,500.00 |
Aetna
| Professional | QZ | $816.40 | $816.40 | $816.40 |
Ambetter
| Professional | AA | $650.00 | $650.00 | $650.00 |
Ambetter
| Professional | QZ | $358.02 | $490.25 | $1,122.00 |