| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $660.69 | $660.69 | $660.69 |
Aetna
| Professional | QX | $302.00 | $380.19 | $707.95 |
Aetna
| Professional | QY | $331.13 | $416.87 | $1,023.29 |
Aetna
| Professional | QZ | $537.03 | $537.03 | $537.03 |