| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $831.76 | $831.76 | $954.99 |
Aetna
| Professional | QZ | $891.25 | $891.25 | $891.25 |
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 |
Highmark BCBS
| Professional | QZ | $891.25 | $891.25 | $891.25 |