| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $3,162.28 | $3,162.28 | $3,162.28 |
Aetna
| Facility | QK | $954.99 | $977.24 | $1,548.82 |
Aetna
| Facility | QX | $758.58 | $1,000.00 | $2,454.71 |
Aetna
| Facility | QY | $602.56 | $602.56 | $691.83 |