| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $592.79 | $592.79 | $592.79 |
Aetna
| Professional | AA | $1,224.30 | $1,540.00 | $1,540.00 |
Aetna
| Professional | QZ | $500.54 | $672.76 | $673.52 |
Cigna
| Professional | AA | $411.42 | $481.02 | $517.96 |
United
| Professional | QZ | $75.00 | $75.00 | $75.00 |