| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $47.86 | $47.86 | $47.86 | |
Aetna
| Professional | AA | $1,230.27 | $1,778.28 | $4,265.80 |
Aetna
| Professional | QK | $109.65 | $537.03 | $3,388.44 |
Aetna
| Professional | QX | $371.54 | $489.78 | $3,388.44 |