| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $70.20 | $70.20 | $80.28 |
Aetna
| Professional | AA | $818.44 | $1,082.90 | $1,258.00 |
Aetna
| Professional | QZ | $504.00 | $1,167.95 | $1,262.40 |
Cigna
| Professional | AA | $581.79 | $581.79 | $661.13 |