| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $489.78 | $933.25 | $2,238.72 |
Aetna
| Professional | QX | $269.15 | $389.05 | $707.95 |
Aetna
| Professional | QY | $269.15 | $389.05 | $1,659.59 |
Aetna
| Professional | QZ | $549.54 | $549.54 | $602.56 |