| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $331.13 | $549.54 | $812.83 |
Aetna
| Professional | QK | $234.42 | $346.74 | $676.08 |
Aetna
| Professional | QX | $245.47 | $338.84 | $645.65 |
Aetna
| Professional | QY | $251.19 | $331.13 | $602.56 |
Aetna
| Professional | QZ | $218.78 | $588.84 | $724.44 |