| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $2,454.71 | $3,715.35 | $5,011.87 |
Aetna
| Professional | QZ | $3,311.31 | $3,311.31 | $3,311.31 |
Ambetter
| Professional | AA | $489.78 | $489.78 | $616.60 |
Ambetter
| Professional | QZ | $407.38 | $407.38 | $407.38 |