| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $5,161.20 | $5,161.20 | $5,161.20 |
Aetna
| Facility | QK | $410.85 | $598.03 | $598.03 |
Aetna
| Facility | QX | $434.12 | $873.24 | $888.72 |
Aetna
| Facility | QY | $373.50 | $373.50 | $373.50 |
Aetna
| Facility | QZ | $1,550.70 | $1,550.70 | $1,550.70 |