| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $960.30 | $960.30 | $960.30 |
Aetna
| Facility | QK | $410.85 | $586.95 | $818.81 |
Aetna
| Facility | QX | $496.52 | $867.09 | $950.65 |
Aetna
| Facility | QY | $827.61 | $827.61 | $827.61 |
Aetna
| Facility | QZ | $2,035.53 | $2,035.53 | $2,035.53 |