| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $287.30 | $887.25 | $954.85 |
Aetna
| Professional | AA | $566.10 | $1,130.50 | $1,685.98 |
Aetna
| Professional | QZ | $406.00 | $928.20 | $1,615.00 |
Cigna
| Professional | AA | $465.43 | $465.43 | $528.90 |