| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $539.99 | $539.99 | $674.25 |
Aetna
| Facility | QX | $1,495.37 | $1,495.37 | $1,495.37 |
Martin's Point
| Facility | QK | $539.99 | $539.99 | $674.25 |
Martin's Point
| Facility | QX | $1,495.37 | $1,495.37 | $1,495.37 |