| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $2,468.10 | $2,468.10 | $2,724.15 |
Aetna
| Facility | QK | $576.59 | $576.59 | $576.59 |
Aetna
| Facility | QX | $369.60 | $369.60 | $369.60 |
Aetna
| Facility | QZ | $681.75 | $681.75 | $1,084.02 |