| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $660.69 | $660.69 | $660.69 |
Aetna
| Professional | QX | $295.12 | $389.05 | $660.69 |
Aetna
| Professional | QY | $331.13 | $416.87 | $1,023.29 |
Aetna
| Professional | QZ | $478.63 | $478.63 | $478.63 |