| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $239.88 | $630.96 | $2,041.74 |
Aetna
| Professional | QK | $162.18 | $398.11 | $676.08 |
Aetna
| Professional | QX | $257.04 | $407.38 | $676.08 |
Aetna
| Professional | QY | $269.15 | $363.08 | $724.44 |
Aetna
| Professional | QZ | $141.25 | $363.08 | $741.31 |