| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $135.34 | $135.34 | $971.10 |
Aetna
| Facility | QZ | $3,006.75 | $3,006.75 | $3,006.75 |
Aetna
| Professional | AA | $832.50 | $1,388.94 | $2,011.10 |
Aetna
| Professional | QZ | $302.39 | $1,243.20 | $1,795.50 |
Cigna
| Professional | AA | $698.15 | $698.15 | $793.35 |