| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $794.33 | $1,479.11 | $2,754.23 |
Aetna
| Professional | QX | $354.81 | $575.44 | $933.25 |
Aetna
| Professional | QY | $331.13 | $630.96 | $977.24 |
Aetna
| Professional | QZ | $616.60 | $933.25 | $1,659.59 |