| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $426.58 | $776.25 | $3,630.78 |
Aetna
| Professional | QK | $323.59 | $446.68 | $812.83 |
Aetna
| Professional | QX | $323.59 | $426.58 | $812.83 |
Aetna
| Professional | QY | $309.03 | $407.38 | $724.44 |
Aetna
| Professional | QZ | $309.03 | $398.11 | $831.76 |