| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $6,949.60 | $6,949.60 | $6,949.60 |
Aetna
| Facility | QK | $392.82 | $392.82 | $392.82 |
Aetna
| Facility | QX | $715.39 | $715.39 | $729.60 |
Aetna
| Facility | QY | $190.53 | $190.53 | $231.95 |
Aetna
| Facility | QZ | $909.00 | $909.00 | $909.00 |
Aetna
| Professional | AA | $627.20 | $1,027.77 | $1,540.00 |
Cigna
| Professional | AA | $274.27 | $320.67 | $345.30 |