| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $2,176.19 | $2,176.19 | $2,176.19 |
Aetna
| Professional | QZ | $369.97 | $369.97 | $412.58 |
Ambetter
| Professional | AA | $474.96 | $1,361.43 | $4,288.00 |
Ambetter
| Professional | QZ | $277.06 | $596.60 | $618.44 |