| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $2,800.00 | $2,800.00 | $2,800.00 |
Aetna
| Professional | QZ | $369.97 | $400.14 | $412.58 |
Ambetter
| Professional | AA | $474.96 | $474.96 | $474.96 |
Ambetter
| Professional | QZ | $277.06 | $277.06 | $618.44 |