| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $1,060.74 | $1,060.74 | $1,121.12 |
Aetna
| Facility | QK | $336.15 | $336.15 | $522.90 |
Aetna
| Facility | QX | $292.88 | $523.14 | $731.92 |
Aetna
| Facility | QZ | $767.27 | $767.27 | $767.27 |