| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $529.07 | $712.50 | $1,877.17 |
Aetna
| Professional | QX | $302.70 | $390.51 | $612.44 |
Aetna
| Professional | QY | $287.74 | $373.07 | $612.44 |
Cigna
| Professional | QX | $120.00 | $120.00 | $120.00 |
Cigna
| Professional | QY | $240.00 | $240.00 | $240.00 |