| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $6,358.17 | $6,358.17 | $6,358.17 |
Aetna
| Facility | QK | $563.47 | $563.47 | $563.47 |
Aetna
| Facility | QX | $455.47 | $741.86 | $887.42 |
Aetna
| Facility | QZ | $2,078.48 | $2,078.48 | $2,078.48 |