| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $224.10 | $224.10 | $224.10 |
Aetna
| Facility | QX | $308.39 | $308.39 | $308.39 |
Martin's Point
| Facility | QK | $224.10 | $224.10 | $224.10 |
Martin's Point
| Facility | QX | $308.39 | $308.39 | $308.39 |