| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $207.03 | $207.03 | $214.50 |
Aetna
| Facility | QZ | $1,314.00 | $1,314.00 | $1,314.00 |
Aetna
| Professional | AA | $677.10 | $980.00 | $1,473.74 |
Cigna
| Professional | AA | $465.43 | $465.43 | $528.90 |