| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $331.13 | $331.13 | $331.13 | |
Aetna
| Professional | AA | $380.19 | $512.86 | $724.44 |
Aetna
| Professional | QK | $58.88 | $58.88 | $60.26 |
Aetna
| Professional | QX | $60.26 | $67.61 | $67.61 |
Aetna
| Professional | QY | $186.21 | $186.21 | $186.21 |
Aetna
| Professional | QZ | $407.38 | $575.44 | $758.58 |