| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QZ | $954.99 | $954.99 | $954.99 |
Aetna
| Professional | AA | $478.63 | $616.60 | $758.58 |
Aetna
| Professional | QK | $63.10 | $63.10 | $63.10 |
Aetna
| Professional | QZ | $512.86 | $660.69 | $831.76 |