| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $489.44 | $489.44 | $489.44 |
Highmark BCBS
| Professional | AA | $496.49 | $757.50 | $3,295.75 |
Highmark BCBS
| Professional | QZ | $532.50 | $727.50 | $847.50 |
United
| Professional | AA | $903.50 | $903.50 | $903.50 |