| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $2,089.30 | $2,089.30 | $2,089.30 |
Aetna
| Professional | QZ | $467.74 | $537.03 | $549.54 |
Ambetter
| Professional | AA | $239.88 | $239.88 | $239.88 |
Ambetter
| Professional | QZ | $199.53 | $199.53 | $199.53 |