| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $1,054.11 | $1,054.11 | $1,054.11 |
Aetna
| Facility | QK | $433.53 | $433.53 | $474.90 |
Aetna
| Facility | QX | $892.90 | $938.18 | $1,052.74 |
Aetna
| Facility | QZ | $1,662.50 | $1,662.50 | $1,781.25 |