| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $381.52 | $381.52 | $464.26 |
Aetna
| Facility | QX | $1,056.51 | $1,056.51 | $1,285.63 |
Martin's Point
| Facility | QK | $381.52 | $381.52 | $464.26 |
Martin's Point
| Facility | QX | $1,056.51 | $1,056.51 | $1,285.63 |