| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.00 | $50.00 | $50.00 | |
Aetna
| Professional | AA | $470.40 | $571.95 | $1,208.64 |
Aetna
| Professional | QK | $162.50 | $311.02 | $405.02 |
Aetna
| Professional | QX | $120.04 | $120.04 | $415.54 |
Aetna
| Professional | QY | $326.07 | $326.07 | $326.07 |