| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.00 | $50.00 | $50.00 | |
Aetna
| Professional | AA | $290.00 | $290.00 | $290.00 |
Aetna
| Professional | QK | $120.04 | $120.04 | $336.11 |
Aetna
| Professional | QX | $90.71 | $142.50 | $330.01 |
Aetna
| Professional | QY | $142.50 | $142.50 | $142.50 |