| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $56.23 | $512.86 | $512.86 | |
Aetna
| Professional | AA | $151.36 | $588.84 | $977.24 |
Aetna
| Professional | QK | $229.09 | $302.00 | $467.74 |
Aetna
| Professional | QX | $239.88 | $316.23 | $467.74 |
Aetna
| Professional | QY | $239.88 | $295.12 | $398.11 |
Aetna
| Professional | QZ | $354.81 | $537.03 | $776.25 |