| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $954.99 | $1,479.11 | $3,090.30 |
Medica
| Facility | QK | $39.81 | $39.81 | $52.48 |
Medica
| Facility | QX | $39.81 | $39.81 | $52.48 |
Medica
| Facility | QY | $39.81 | $39.81 | $52.48 |