| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $691.83 | $870.96 | $1,258.93 |
Aetna
| Professional | QX | $575.44 | $724.44 | $933.25 |
Aetna
| Professional | QZ | $407.38 | $602.56 | $602.56 |
HMSA
| Professional | QZ | $3.72 | $3.98 | $4.37 |