| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.00 | $50.00 | $50.00 | |
Aetna
| Professional | AA | $392.00 | $470.40 | $997.13 |
Aetna
| Professional | QK | $69.19 | $162.50 | $326.07 |
Aetna
| Professional | QX | $280.92 | $280.92 | $330.01 |
Aetna
| Professional | QY | $276.75 | $276.75 | $276.75 |