| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $980.00 | $980.00 | $1,076.14 |
Aetna
| Professional | QZ | $1,453.50 | $1,453.50 | $1,453.50 |
Cigna
| Professional | AA | $346.28 | $435.42 | $732.79 |
Health Partners
| Professional | AA | $257.14 | $417.75 | $1,025.50 |