| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $401.70 | $401.70 | $401.70 |
Aetna
| Professional | AA | $1,512.00 | $1,887.00 | $2,358.75 |
Aetna
| Professional | QZ | $672.00 | $672.00 | $672.00 |
Cigna
| Professional | AA | $698.15 | $698.15 | $793.35 |