| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,216.59 | $1,216.59 | $1,216.59 |
Aetna
| Professional | QZ | $900.00 | $900.00 | $900.00 |
Ambetter
| Professional | AA | $180.45 | $180.45 | $180.45 |
Ambetter
| Professional | QZ | $177.30 | $177.30 | $177.30 |