| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $639.60 | $639.60 | $639.60 |
Aetna
| Professional | AA | $1,121.09 | $1,776.50 | $4,022.20 |
Aetna
| Professional | QZ | $619.20 | $674.41 | $2,165.80 |
Cigna
| Professional | AA | $814.51 | $814.51 | $925.58 |