| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $741.31 | $741.31 | $831.76 |
Aetna
| Professional | QX | $263.03 | $354.81 | $575.44 |
Aetna
| Professional | QY | $371.54 | $371.54 | $407.38 |
Aetna
| Professional | QZ | $630.96 | $691.83 | $812.83 |