| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $540.20 | $658.60 | $821.40 |
Aetna
| Professional | QK | $266.39 | $314.50 | $372.00 |
Aetna
| Professional | QX | $100.39 | $100.39 | $100.39 |
Aetna
| Professional | QY | $266.39 | $299.70 | $300.00 |