| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $436.52 | $851.14 | $1,348.96 |
Aetna
| Professional | QX | $245.47 | $363.08 | $537.03 |
Aetna
| Professional | QY | $269.15 | $269.15 | $389.05 |
Aetna
| Professional | QZ | $72.44 | $269.15 | $602.56 |
Cigna
| Professional | AA | $467.74 | $467.74 | $524.81 |