| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $1,035.35 | $1,035.35 | $1,035.35 |
Aetna
| Facility | QX | $789.28 | $808.07 | $916.63 |
Aetna
| Facility | QY | $709.42 | $709.42 | $709.42 |
Aetna
| Facility | QZ | $1,243.35 | $1,243.35 | $1,243.35 |