| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $2,324.32 | $2,324.32 | $2,324.32 |
Aetna
| Facility | QY | $839.34 | $839.34 | $839.34 |
Martin's Point
| Facility | QX | $2,324.32 | $2,324.32 | $2,324.32 |
Martin's Point
| Facility | QY | $839.34 | $839.34 | $839.34 |