| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $222.30 | $222.30 | $288.60 |
Aetna
| Professional | AA | $921.30 | $1,260.00 | $1,856.40 |
Aetna
| Professional | QZ | $361.73 | $533.40 | $2,516.00 |
Cigna
| Professional | AA | $698.15 | $698.15 | $793.35 |