| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $351.78 | $351.78 | $351.78 |
Aetna
| Facility | QX | $974.16 | $974.16 | $974.16 |
Highmark BCBS
| Professional | QZ | $466.86 | $466.86 | $507.45 |
Martin's Point
| Facility | QK | $351.78 | $351.78 | $351.78 |
Martin's Point
| Facility | QX | $974.16 | $974.16 | $974.16 |