| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $794.33 | $1,778.28 | $3,090.30 |
Aetna
| Professional | QX | $380.19 | $616.60 | $954.99 |
Aetna
| Professional | QY | $416.87 | $676.08 | $1,778.28 |
Aetna
| Professional | QZ | $645.65 | $933.25 | $1,288.25 |