| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $1,581.18 | $1,581.18 | $1,581.18 |
Aetna
| Facility | QK | $1,011.00 | $1,011.00 | $1,011.00 |
Aetna
| Facility | QX | $455.83 | $519.06 | $598.12 |
Aetna
| Facility | QZ | $805.80 | $805.80 | $805.80 |