| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $851.14 | $1,318.26 | $2,630.27 |
Aetna
| Professional | QX | $398.11 | $676.08 | $977.24 |
Aetna
| Professional | QY | $436.52 | $660.69 | $1,778.28 |
Aetna
| Professional | QZ | $575.44 | $602.56 | $645.65 |