| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $302.00 | $302.00 | $302.00 |
Aetna
| Professional | AA | $630.96 | $1,258.93 | $2,137.96 |
Aetna
| Professional | QZ | $512.86 | $912.01 | $1,698.24 |
Cigna
| Professional | AA | $467.74 | $467.74 | $524.81 |