| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $691.83 | $1,258.93 | $2,398.83 |
Aetna
| Professional | QX | $575.44 | $776.25 | $1,318.26 |
Aetna
| Professional | QY | $245.47 | $426.58 | $616.60 |
Aetna
| Professional | QZ | $794.33 | $1,258.93 | $1,949.84 |