| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $373.50 | $373.50 | $373.50 |
Aetna
| Facility | QX | $160.72 | $160.72 | $185.49 |
Martin's Point
| Facility | QK | $373.50 | $373.50 | $373.50 |
Martin's Point
| Facility | QX | $160.72 | $160.72 | $185.49 |