| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $944.99 | $944.99 | $944.99 |
Aetna
| Facility | QX | $1,568.45 | $1,568.45 | $3,234.55 |
Martin's Point
| Facility | QK | $944.99 | $944.99 | $944.99 |
Martin's Point
| Facility | QX | $1,568.45 | $3,234.55 | $3,234.55 |