| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $410.74 | $426.80 | $627.20 |
Aetna
| Professional | QK | $216.94 | $216.94 | $216.94 |
Aetna
| Professional | QY | $649.64 | $649.64 | $649.64 |
Aetna
| Professional | QZ | $399.17 | $399.17 | $399.17 |
HMSA
| Professional | QZ | $3.72 | $4.18 | $4.38 |