| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $1,316.69 | $1,316.69 | $1,316.69 |
Aetna
| Professional | AA | $1,170.00 | $1,445.00 | $1,981.95 |
Aetna
| Professional | QZ | $1,008.88 | $1,372.75 | $1,372.75 |
Cigna
| Professional | AA | $411.42 | $481.02 | $517.96 |