| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $97.50 | $97.50 | $179.40 |
Aetna
| Professional | AA | $130.33 | $682.03 | $1,082.90 |
Aetna
| Professional | QZ | $115.74 | $765.90 | $943.50 |
Cigna
| Professional | AA | $465.43 | $465.43 | $528.90 |