| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $611.10 | $611.10 | $960.30 |
Aetna
| Facility | QK | $390.15 | $398.68 | $522.90 |
Aetna
| Facility | QX | $532.35 | $532.35 | $716.17 |
Aetna
| Facility | QY | $263.16 | $296.60 | $426.90 |
Aetna
| Facility | QZ | $614.97 | $673.40 | $865.80 |
Aetna
| Professional | AA | $460.17 | $816.00 | $1,415.47 |
Cigna
| Professional | AA | $274.27 | $320.67 | $345.30 |