| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $434.12 | $434.12 | $434.12 |
Aetna
| Facility | QX | $434.12 | $576.05 | $643.83 |
Martin's Point
| Facility | QK | $434.12 | $434.12 | $434.12 |
Martin's Point
| Facility | QX | $183.69 | $434.12 | $643.83 |