| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $557.70 | $557.70 | $557.70 |
Aetna
| Professional | AA | $721.50 | $1,237.59 | $1,547.00 |
Aetna
| Professional | QZ | $182.46 | $272.68 | $899.10 |
Cigna
| Professional | AA | $698.15 | $698.15 | $793.35 |