| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $208.93 | $208.93 | $213.80 |
Aetna
| Facility | QZ | $1,318.26 | $1,318.26 | $7,244.36 |
Aetna
| Professional | AA | $407.38 | $812.83 | $1,288.25 |
Cigna
| Professional | AA | $467.74 | $467.74 | $524.81 |