| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $714.78 | $714.78 | $820.98 |
Aetna
| Facility | QY | $774.02 | $774.02 | $774.02 |
Aetna
| Professional | AA | $1,226.29 | $1,773.59 | $2,520.00 |
Aetna
| Professional | QZ | $288.14 | $850.95 | $850.95 |
Cigna
| Professional | AA | $479.99 | $561.18 | $604.28 |