| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $211.25 | $452.40 | $591.50 |
Aetna
| Professional | AA | $854.81 | $1,392.30 | $1,768.49 |
Cigna
| Professional | AA | $698.15 | $698.15 | $793.35 |
United
| Professional | AA | $85.00 | $85.00 | $85.00 |