| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $903.87 | $903.87 | $903.87 |
Aetna
| Facility | QK | $572.22 | $572.22 | $597.60 |
Aetna
| Facility | QX | $510.17 | $670.09 | $868.87 |
Aetna
| Facility | QY | $293.48 | $375.65 | $792.38 |
Aetna
| Facility | QZ | $722.00 | $769.60 | $962.00 |