| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $288.40 | $891.25 | $954.99 |
Aetna
| Professional | AA | $524.81 | $1,071.52 | $1,737.80 |
Aetna
| Professional | QZ | $426.58 | $691.83 | $1,230.27 |
Cigna
| Professional | AA | $467.74 | $467.74 | $524.81 |