| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $448.20 | $448.20 | $896.40 |
Aetna
| Facility | QZ | $1,867.25 | $1,867.25 | $1,867.25 |
Martin's Point
| Facility | QK | $448.20 | $448.20 | $896.40 |
Martin's Point
| Facility | QZ | $1,867.25 | $1,867.25 | $1,867.25 |