| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $451.05 | $733.04 | $780.82 |
Aetna
| Facility | QZ | $3,763.80 | $3,763.80 | $3,763.80 |
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| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $451.05 | $733.04 | $780.82 |
Aetna
| Facility | QZ | $3,763.80 | $3,763.80 | $3,763.80 |