| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $436.52 | $436.52 | $436.52 |
Aetna
| Professional | QX | $199.53 | $257.04 | $309.03 |
Aetna
| Professional | QZ | $100.00 | $549.54 | $602.56 |
Cigna
| Professional | AA | $263.03 | $331.13 | $363.08 |