| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $960.30 | $960.30 | $960.30 |
Aetna
| Facility | QK | $927.81 | $927.81 | $927.81 |
Aetna
| Facility | QX | $589.68 | $589.68 | $589.68 |
Aetna
| Facility | QY | $569.34 | $569.34 | $569.34 |
Aetna
| Facility | QZ | $871.79 | $871.79 | $871.79 |