| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $478.63 | $1,174.90 | $2,187.76 |
Aetna
| Professional | QZ | $173.78 | $954.99 | $1,288.25 |
Cigna
| Facility | QK | $30.90 | $30.90 | $30.90 |
Cigna
| Facility | QX | $30.90 | $30.90 | $30.90 |
Cigna
| Facility | QY | $30.90 | $30.90 | $30.90 |
Cigna
| Professional | AA | $416.87 | $524.81 | $691.83 |