| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $275.00 | $275.00 | $275.00 | |
Aetna
| Professional | AA | $693.00 | $814.32 | $2,363.76 |
Aetna
| Professional | QX | $957.40 | $957.40 | $957.40 |
Aetna
| Professional | QZ | $127.81 | $530.10 | $2,101.12 |