| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | QX | $377.88 | $377.88 | $377.88 |
Anes Perq Img Dstrj Px Nulyt Agt Spi/Sp Crv/Thrc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | QX | $377.88 | $377.88 | $377.88 |