| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $134.90 | $134.90 | $977.24 |
Aetna
| Facility | QZ | $3,019.95 | $3,019.95 | $3,019.95 |
Aetna
| Professional | AA | $660.69 | $1,202.26 | $2,041.74 |
Aetna
| Professional | QZ | $602.56 | $933.25 | $1,584.89 |
Cigna
| Professional | AA | $691.83 | $691.83 | $794.33 |