| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $436.52 | $676.08 | $1,862.09 |
Aetna
| Professional | QX | $257.04 | $380.19 | $602.56 |
Aetna
| Professional | QY | $281.84 | $338.84 | $616.60 |
Aetna
| Professional | QZ | $199.53 | $199.53 | $199.53 |