| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $928.82 | $928.82 | $928.82 |
Aetna
| Facility | QX | $2,572.13 | $2,572.13 | $2,572.13 |
Martin's Point
| Facility | QK | $928.82 | $928.82 | $928.82 |
Martin's Point
| Facility | QX | $2,572.13 | $2,572.13 | $2,572.13 |