| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $338.84 | $630.96 | $1,548.82 |
Ambetter
| Professional | AA | $128.82 | $194.98 | $758.58 |
Cigna
| Facility | QK | $30.90 | $30.90 | $30.90 |
Cigna
| Facility | QX | $30.90 | $30.90 | $30.90 |
Cigna
| Facility | QY | $30.90 | $30.90 | $30.90 |