| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $3,170.20 | $3,170.20 | $3,170.20 |
Aetna
| Professional | QZ | $1,560.90 | $1,560.90 | $1,560.90 |
Ambetter
| Professional | AA | $1,170.00 | $1,820.00 | $4,940.00 |
Ambetter
| Professional | QZ | $393.87 | $1,560.00 | $2,240.00 |