| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $548.79 | $627.20 | $1,757.34 |
Aetna
| Professional | QK | $415.54 | $451.49 | $530.17 |
Aetna
| Professional | QX | $406.34 | $436.58 | $457.62 |
Aetna
| Professional | QY | $649.64 | $649.64 | $649.64 |