| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $436.52 | $436.52 | $436.52 |
Aetna
| Facility | QX | $181.97 | $436.52 | $645.65 |
Aetna
| Professional | AA | $3,388.44 | $3,388.44 | $4,466.84 |
Martin's Point
| Facility | QK | $436.52 | $436.52 | $436.52 |
Martin's Point
| Facility | QX | $181.97 | $436.52 | $645.65 |
Martin's Point
| Professional | AA | $616.60 | $1,096.48 | $4,466.84 |