| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $223.87 | $223.87 | $288.40 |
Aetna
| Professional | AA | $660.69 | $1,174.90 | $1,737.80 |
Aetna
| Professional | QZ | $467.74 | $758.58 | $1,513.56 |
Cigna
| Professional | AA | $691.83 | $691.83 | $794.33 |