| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $213.80 | $537.03 | $812.83 |
Aetna
| Professional | QK | $229.09 | $338.84 | $630.96 |
Aetna
| Professional | QX | $239.88 | $338.84 | $562.34 |
Aetna
| Professional | QY | $245.47 | $309.03 | $676.08 |
Aetna
| Professional | QZ | $281.84 | $562.34 | $676.08 |