| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $634.95 | $747.00 | $772.50 |
Aetna
| Facility | QX | $710.37 | $879.39 | $879.39 |
Martin's Point
| Facility | QK | $634.95 | $747.00 | $772.50 |
Martin's Point
| Facility | QX | $710.37 | $710.37 | $879.39 |