| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $70.79 | $70.79 | $79.43 |
Aetna
| Professional | AA | $288.40 | $851.14 | $1,096.48 |
Aetna
| Professional | QZ | $407.38 | $478.63 | $1,174.90 |
Cigna
| Professional | AA | $575.44 | $575.44 | $660.69 |