| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,228.07 | $1,228.07 | $1,228.07 |
Aetna
| Professional | QX | $300.72 | $305.33 | $311.44 |
Aetna
| Professional | QZ | $1,432.75 | $1,432.75 | $1,432.75 |
Cigna
| Professional | AA | $581.79 | $581.79 | $661.13 |