| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $97.18 | $97.18 | $97.18 |
Aetna
| Professional | AA | $810.30 | $1,221.15 | $1,768.14 |
Aetna
| Professional | QZ | $674.41 | $954.60 | $1,453.50 |
Cigna
| Professional | AA | $698.15 | $698.15 | $793.35 |