| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $48.00 | $48.00 | $555.00 | |
Aetna
| Professional | AA | $108.07 | $700.00 | $700.00 |
Aetna
| Professional | QZ | $1,268.41 | $1,268.41 | $1,268.41 |
Cigna
| Professional | AA | $581.79 | $581.79 | $661.13 |
Quartz
| Professional | $306.89 | $346.15 | $625.00 |