| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $4,488.00 | $4,488.00 | $4,488.00 |
Aetna
| Facility | QK | $149.31 | $149.31 | $168.61 |
Aetna
| Facility | QX | $180.41 | $194.81 | $245.81 |
Aetna
| Facility | QY | $166.02 | $166.02 | $166.02 |
Aetna
| Facility | QZ | $422.63 | $491.40 | $583.58 |