| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $37.50 | $600.00 | |
Aetna
| Facility | QK | $927.69 | $972.40 | $1,496.00 |
Aetna
| Facility | QX | $785.40 | $939.40 | $2,464.00 |
Medcost
| Facility | $30.00 | $1,950.00 | $3,000.00 |