| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | QX | $65.02 | $65.02 | $65.02 |
Aetna
| Professional | QY | $440.00 | $440.00 | $440.00 |
Cigna
| Professional | AA | $277.02 | $348.34 | $586.23 |
Health Partners
| Professional | AA | $205.72 | $334.20 | $820.40 |
United
| Professional | QX | $90.00 | $90.00 | $90.00 |