| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $173.78 | $741.31 | $1,318.26 |
Aetna
| Professional | QK | $91.20 | $562.34 | $724.44 |
Aetna
| Professional | QX | $467.74 | $562.34 | $812.83 |
Aetna
| Professional | QY | $123.03 | $537.03 | $660.69 |
Aetna
| Professional | QZ | $316.23 | $549.54 | $831.76 |