| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QZ | $564.29 | $564.29 | $798.00 |
Aetna
| Professional | AA | $619.85 | $804.98 | $1,643.50 |
Aetna
| Professional | QZ | $405.51 | $788.50 | $1,368.00 |
Cigna
| Professional | AA | $411.42 | $411.42 | $514.28 |