| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $3,197.70 | $3,197.70 | $3,197.70 |
Aetna
| Facility | QK | $960.50 | $963.56 | $1,551.42 |
Aetna
| Facility | QX | $906.78 | $994.00 | $2,433.19 |
Aetna
| Facility | QY | $573.38 | $573.38 | $697.00 |