| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $56.00 | $56.00 | $499.70 | |
Aetna
| Professional | AA | $150.00 | $700.00 | $980.00 |
Aetna
| Professional | QK | $299.82 | $396.59 | $475.90 |
Aetna
| Professional | QX | $290.83 | $380.72 | $449.73 |
Aetna
| Professional | QY | $285.54 | $333.13 | $380.72 |
Aetna
| Professional | QZ | $360.00 | $360.00 | $360.00 |