| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $965.20 | $965.20 | $965.20 |
Aetna
| Professional | QZ | $1,689.10 | $1,689.10 | $1,689.10 |
Ambetter
| Professional | AA | $715.00 | $897.00 | $1,568.00 |
Ambetter
| Professional | QZ | $165.84 | $1,300.00 | $1,560.00 |