| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $444.66 | $444.66 | $444.66 |
Aetna
| Facility | QX | $418.29 | $632.20 | $849.63 |
Aetna
| Facility | QY | $225.42 | $225.42 | $225.42 |
Aetna
| Facility | QZ | $967.19 | $967.19 | $967.19 |
Aetna
| Professional | QZ | $679.00 | $865.18 | $920.79 |