| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $854.10 | $854.10 | $854.10 |
Aetna
| Professional | AA | $1,520.82 | $2,240.00 | $3,500.00 |
Aetna
| Professional | QZ | $930.00 | $1,909.20 | $1,909.20 |
Cigna
| Professional | AA | $1,047.22 | $1,047.22 | $1,190.03 |