| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $275.42 | $275.42 | $275.42 | |
Aetna
| Professional | AA | $354.81 | $575.44 | $776.25 |
Aetna
| Professional | QK | $165.96 | $165.96 | $165.96 |
Aetna
| Professional | QX | $60.26 | $954.99 | $954.99 |
Aetna
| Professional | QZ | $416.87 | $575.44 | $724.44 |