| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $487.70 | $487.70 | $487.70 |
Aetna
| Facility | QX | $1,350.54 | $1,350.54 | $1,350.54 |
Martin's Point
| Facility | QK | $487.70 | $487.70 | $487.70 |
Martin's Point
| Facility | QX | $1,350.54 | $1,350.54 | $1,350.54 |