| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $524.81 | $1,288.25 | $3,630.78 |
Aetna
| Professional | QX | $426.58 | $676.08 | $1,071.52 |
Aetna
| Professional | QY | $457.09 | $831.76 | $2,137.96 |
Aetna
| Professional | QZ | $575.44 | $602.56 | $645.65 |