| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $630.96 | $1,096.48 | $1,949.84 |
Aetna
| Professional | QX | $363.08 | $575.44 | $977.24 |
Aetna
| Professional | QY | $331.13 | $575.44 | $870.96 |
Aetna
| Professional | QZ | $575.44 | $707.95 | $1,202.26 |