| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $78.51 | $78.51 | $473.00 |
Aetna
| Professional | QX | $65.02 | $283.80 | $369.80 |
Cigna
| Professional | QX | $120.00 | $120.00 | $120.00 |
Cigna
| Professional | QY | $120.00 | $120.00 | $120.00 |