| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $97.72 | $97.72 | $97.72 |
Aetna
| Professional | AA | $676.08 | $1,047.13 | $1,778.28 |
Aetna
| Professional | QZ | $537.03 | $870.96 | $1,380.38 |
Cigna
| Professional | AA | $691.83 | $691.83 | $794.33 |