| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $1,198.85 | $1,198.85 | $1,198.85 |
Aetna
| Facility | QK | $690.74 | $690.74 | $820.39 |
Aetna
| Facility | QX | $626.08 | $703.96 | $703.96 |
Aetna
| Facility | QZ | $865.80 | $865.80 | $962.00 |