| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $380.19 | $537.03 | $1,174.90 |
Aetna
| Professional | QX | $245.47 | $363.08 | $537.03 |
Aetna
| Professional | QY | $269.15 | $269.15 | $389.05 |
Aetna
| Professional | QZ | $199.53 | $602.56 | $630.96 |