| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $815.37 | $815.37 | $815.37 |
Aetna
| Professional | QX | $109.57 | $315.00 | $453.90 |
Aetna
| Professional | QZ | $617.40 | $970.20 | $1,234.80 |
Cigna
| Professional | AA | $379.30 | $476.94 | $521.64 |