| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $583.00 | $737.00 | $828.00 |
Aetna
| Professional | QX | $264.60 | $352.96 | $368.50 |
Aetna
| Professional | QY | $368.50 | $368.50 | $368.50 |
Aetna
| Professional | QZ | $632.50 | $690.00 | $816.50 |