| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $382.87 | $382.87 | $386.90 |
Aetna
| Facility | QX | $633.91 | $774.14 | $796.45 |
Aetna
| Facility | QY | $228.91 | $228.91 | $228.91 |
Aetna
| Facility | QZ | $1,662.50 | $1,662.50 | $1,662.50 |