| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $563.47 | $563.47 | $563.47 |
Aetna
| Facility | QX | $1,560.38 | $1,560.38 | $1,560.38 |
Martin's Point
| Facility | QK | $563.47 | $563.47 | $563.47 |
Martin's Point
| Facility | QX | $1,560.38 | $1,560.38 | $1,560.38 |